[PHIC]The Division of Workforce Development (DWD) Fellowship Alumni Assessment

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-1078 Att L_SAF Alumni Survey	Form and Instruction	New	Available
Form 0920-1078 SAF Alumni	Form and Instruction	New	Repair queued
Form 0920-1078 Att K_PHAP Alumni Survey	Form and Instruction	New	Available
Form 0920-1078 PHAP Alumni	Form and Instruction	New	Repair queued
Form 0920-1078 Att J_PHIFP Alumni Survey	Form and Instruction	New	Available
Form 0920-1078 PHIFP Alumni	Form and Instruction	New	Repair queued
Form 0920-1078 Att I_PE Alumni Survey	Form and Instruction	New	Available
Form 0920-1078 PE Fellowship Alumni	Form and Instruction	New	Repair queued
Form 0920-1078 Att H_FLIGHT Alumni Survey	Form and Instruction	New	Available
Form 0920-1078 FLIGHT Alumni	Form and Instruction	New	Repair queued
Form 0920-1078 Att G_EIS-LLS Alumni Survey	Form and Instruction	New	Repair queued
Form 0920-1078 EIS/LLS Alumni	Form and Instruction	New	Repair queued
Form 0920-1078 Att F_EFP Alumni Survey	Form and Instruction	New	Available
Form 0920-1078 EFP Alumni	Form and Instruction	New	Repair queued
Form 0920-1078 Att E_EEP Alumni Survey	Form and Instruction	New	Available
Form 0920-1078 EEP Alumni Survey	Form and Instruction	New	Available
PHAP Alumni Assessment	Form and Instruction	Removed	Available
PHAP Alumni Survey	Form and Instruction	Removed	Repair queued
PHAP Host Site Supervisor Survey	Form and Instruction	Removed	Repair queued
PHAP Host Site Supervisor Survey	Form and Instruction	Removed	Repair queued
Att N_Acronym List.docx	Supplementary Document	Uploaded 2024-02-16	Repair queued
Att M_Privacy Act Checklist.docx	Supplementary Document	Uploaded 2024-02-16	Repair queued
Att L-2_SAF Reminder Email.docx	Supplementary Document	Uploaded 2024-02-16	Repair queued
Att L-1_SAF Invitation Email.docx	Supplementary Document	Uploaded 2024-02-16	Repair queued
Att K-2_PHAP Reminder Email.docx	Supplementary Document	Uploaded 2024-02-16	Repair queued
Att K-1_PHAP Initial Email.docx	Supplementary Document	Uploaded 2024-02-16	Repair queued
Att J-2_PHIFP Reminder Email.docx	Supplementary Document	Uploaded 2024-02-16	Available
Att J-1_PHIFP Initial Email.docx	Supplementary Document	Uploaded 2024-02-16	Repair queued
Att I-2_PE Reminder Email.docx	Supplementary Document	Uploaded 2024-02-16	Repair queued
Att I-1_PE Initial Email.docx	Supplementary Document	Uploaded 2024-02-16	Repair queued
Att H-2_FLIGHT Reminder Email.docx	Supplementary Document	Uploaded 2024-02-16	Repair queued
Att H-1_FLIGHT Initial Email.docx	Supplementary Document	Uploaded 2024-02-16	Repair queued
Att G-2_EIS-LLS Reminder Email.docx	Supplementary Document	Uploaded 2024-02-16	Repair queued
Att G-1_EIS-LLS Initial Email.docx	Supplementary Document	Uploaded 2024-02-16	Repair queued
Att F-2_EFP Reminder Email.docx	Supplementary Document	Uploaded 2024-02-16	Repair queued
Att F-1_EFP Initial Email.docx	Supplementary Document	Uploaded 2024-02-16	Repair queued
Att E-2_EEP Reminder Email.docx	Supplementary Document	Uploaded 2024-02-16	Repair queued
Att E-1_EEP Initial Email.docx	Supplementary Document	Uploaded 2024-02-16	Repair queued
Att D_Alumni Survey Screen Shots.docx	Supplementary Document	Uploaded 2024-02-16	Repair queued
Att A_Public Health Service Act.docx	Supplementary Document	Uploaded 2024-02-16	Repair queued
Attachment N_PHAP Alumni Survey Reminder Email 2-FINAL.docx	Supplementary Document	Uploaded 2020-12-01	Repair queued
Attachment M_PHAP Alumni Survey Reminder Email-FINAL.docx	Supplementary Document	Uploaded 2020-12-01	Repair queued
Attachment K_PHAP Alumni Survey Email Invitation_FINAL.docx	Supplementary Document	Uploaded 2020-12-01	Repair queued
Attachment J_PHAP Host Site Supervisor Survey Final Reminder_FINAL.docx	Supplementary Document	Uploaded 2020-12-01	Repair queued
Attachment I_PHAP Host Site Supervisor Survey Second Reminder Email_FINAL.docx	Supplementary Document	Uploaded 2020-12-01	Repair queued
Attachment H_PHAP Host Site Supervisor Survey Reminder Email_FINAL.docx	Supplementary Document	Uploaded 2020-12-01	Repair queued
Attachment G_PHAP Host Site Supervisor Survey Invitation Email_FINAL.docx	Supplementary Document	Uploaded 2020-12-01	Repair queued
Attachment E_PHAP Host Site Supervisor Survey Respondent Information_FINAL.docx	Supplementary Document	Uploaded 2020-12-01	Repair queued
Attachment D_Published 60 day_11022020.pdf	Supplementary Document	Uploaded 2020-12-01	Repair queued
Attachment A_Public Health Service Act_FINAL.docx	Supplementary Document	Uploaded 2020-12-01	Repair queued
DWD Alumni Survey ICR- Statement B Revision.docx	Supporting Statement B	Uploaded 2024-02-16	Repair queued
DWD Alumni ICR- Statement A Revision.docx	Supporting Statement A	Uploaded 2024-02-16	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
265458	SAF Alumni	Form and Instruction	New	Att L_SAF Alumni Survey
265458	SAF Alumni	Form and Instruction	New
265457	PHAP Alumni	Form and Instruction	New	Att K_PHAP Alumni Survey
265457	PHAP Alumni	Form and Instruction	New
265456	PHIFP Alumni	Form and Instruction	New	Att J_PHIFP Alumni Survey
265456	PHIFP Alumni	Form and Instruction	New
265455	PE Fellowship Alumni	Form and Instruction	New	Att I_PE Alumni Survey
265455	PE Fellowship Alumni	Form and Instruction	New
265454	FLIGHT Alumni	Form and Instruction	New	Att H_FLIGHT Alumni Survey
265454	FLIGHT Alumni	Form and Instruction	New
265453	EIS/LLS Alumni	Form and Instruction	New	Att G_EIS-LLS Alumni Survey
265453	EIS/LLS Alumni	Form and Instruction	New
265452	EFP Alumni	Form and Instruction	New	Att F_EFP Alumni Survey
265452	EFP Alumni	Form and Instruction	New
265415	EEP Alumni Survey	Form and Instruction	New	Att E_EEP Alumni Survey
265415	EEP Alumni Survey	Form and Instruction	New
229893	PHAP Alumni Survey	Form and Instruction	Removed	PHAP Alumni Assessment
229893	PHAP Alumni Survey	Form and Instruction	Removed
229893	PHAP Alumni Survey	Other-WORD version of survey to facilitate review of content	Removed
229891	PHAP Host Site Supervisor Survey	Form and Instruction	Removed	PHAP Host Site Supervisor Survey
229891	PHAP Host Site Supervisor Survey	Form and Instruction	Removed
229891	PHAP Host Site Supervisor Survey	Other-WORD version of survey to facilitate review of content	Removed

ICR Details

OMB Control No: 0920-1078	ICR Reference No: 202402-0920-007
Status: Historical Active	Previous ICR Reference No: 202010-0920-018
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1078
Title: [PHIC]The Division of Workforce Development (DWD) Fellowship Alumni Assessment
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/25/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/22/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2027	36 Months From Approved	03/31/2024
Responses	645	0	1,000
Time Burden (Hours)	175	0	213
Cost Burden (Dollars)	0	0	7,474

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Abstract: This information collection request (ICR) is to gain three-year approval to follow alumni career progression following participation in the Public Health Associate Program (PHAP). The subpopulations to be studied are the PHAP Host Site Supervisors and PHAP Alumni. Information will be collected through online surveys. Findings will be used to assess the quality and value of the PHAP.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 74193	10/30/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 9150	02/09/2024
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 8

table that charts list of burden

IC Title	Form No.	Form Name
EEP Alumni Survey	0920-1078	Att E_EEP Alumni Survey
EFP Alumni	0920-1078	Att F_EFP Alumni Survey
EIS/LLS Alumni	0920-1078	Att G_EIS-LLS Alumni Survey
FLIGHT Alumni	0920-1078	Att H_FLIGHT Alumni Survey
PE Fellowship Alumni	0920-1078	Att I_PE Alumni Survey
PHAP Alumni	0920-1078	Att K_PHAP Alumni Survey
PHAP Alumni Survey	n/a	PHAP Alumni Assessment
PHAP Host Site Supervisor Survey	n/a	PHAP Host Site Supervisor Survey
PHIFP Alumni	0920-1078	Att J_PHIFP Alumni Survey
SAF Alumni	0920-1078	Att L_SAF Alumni Survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	645	1,000	0	645	-1,000	0
Annual Time Burden (Hours)	175	213	0	175	-213	0
Annual Cost Burden (Dollars)	0	7,474	0	0	-7,474	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This a revision to an existing collection requesting 175 annual burden hours.

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Annual Cost to Federal Government: $60,145

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  Yes

Description/Changes for Common Form Usage:  Title Change to "The Division of Workforce Development (DWD) Fellowship Alumni Assessment"

Approved RCFs using this ICR

table that charts list of RCF

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 02/22/2024

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