PHL Fellow Application

[PHIC] Public Health Law Fellowship Program

Documents and Forms

Document Name Document Type
Form 0920-23DP PHL Fellow Application Form and Instruction
0920-23DP PHL Fellow Application Att.E-1_PHLFellowApp_WordVersion.docx Form and Instruction
0920-23DP PHL Fellow Application Att.E-1_PHLFellowApp_WordVersion.docx Form and Instruction

Information Collection (IC) Details

IC Title:	PHL Fellow Application	Agency IC Tracking Number:	0920-23DP

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-23DP	PHL Fellow Application	Att.E-1_PHLFellowApp_WordVersion.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.