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View Information Collection (IC)
View Information Collection (IC)
IC Title:
[CSELS] Field Epidemiology Training Program (FETP) Mentorship Activities Assessment
Agency IC Tracking Number:
0920-22BN
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
n/a
FETP Mentor Survey (screen shots)
1a_FETP Mentor Survey PDF.pdf
Yes
Yes
Fillable Fileable
Other-WORD document to facilitate content review of FETP Mentor Survey
1b_FETP Mentor Survey.docx
No
Paper Only
Form and Instruction
n/a
FETP Mentor Interview
1c_KII Template Mentors Interview.docx
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
FETP Mentee Survey (screen shots)
2a_FETP Mentee Survey PDF.pdf
Yes
Yes
Fillable Fileable
Other-WORD document to facilitate content review of FETP Mentee Survey
2b_FETP Mentee Survey.docx
No
Paper Only
Form and Instruction
n/a
FETP Mentee Interview
2c_KII Template Mentee Interview.docx
Yes
Yes
Fillable Fileable
Form and Instruction
n/a
FETP Program Staff Survey (screen shots)
3a_FETP Program Staff Survey PDF.pdf
Yes
Yes
Fillable Fileable
Other-WORD document to facilitate content review of FETP Program Staff Survey
3b_FETP Program Staff Survey.docx
No
Paper Only
Form and Instruction
n/a
FETP Program Staff Interview
3c_KII Template Program Staff Interview.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Training and Employment
Privacy Act System of Records
Title:
09-20-0161 Records of Health Professionals in Disease Prevention and Control Programs
FR Citation:
51 FR 42485
Number of Respondents:
919
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
919
0
919
0
0
0
Annual IC Time Burden (Hours)
312
0
312
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
GENIC Template with description of the FETP Assessment
Request for Approval Under GenIC for FETP Mentorship Assessment.docx
01/14/2022
Recruitment Email
AttachmentA_Participant Recruitment_Email_GenIC_FETP Mentorship Assessment.docx
01/14/2022
Follow-up Email
AttachmentB_Participant Recruitment Follow Up Email_GenIC_FETP Mentorship Assessment.docx
01/14/2022
Request for Participation and Consent
AttachmentC_Recruitment and Consent Letter Survey Participants.docx
01/14/2022
CDC Non-Research Determination: IRB Approval is Not Required
AttachmentD_NRD_approval_FETP_mentorship.docx
01/14/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.