View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0920-0765
ICR Reference No:
201703-0920-011
Status:
Historical Active
Previous ICR Reference No:
201509-0920-009
Agency/Subagency:
HHS/CDC
Agency Tracking No:
18896
Title:
Fellowship Management System
Type of Information Collection:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
03/23/2017
Retrieve Notice of Action (NOA)
Date Received in OIRA:
03/23/2017
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
04/30/2018
04/30/2018
04/30/2018
Responses
3,781
0
3,751
Time Burden (Hours)
4,450
0
4,390
Cost Burden (Dollars)
0
0
0
Abstract:
The purpose of this change request is for OMB approval of proposed modifications to accommodate changing needs of the fellowship program that reflect evolving fellowship eligibility requirements. Specifically, this change request will support collection of previously identified data elements from an estimated 30 new respondents who are nonfederal applicants to PMR/F in the FMS application module. It will also collect limited new data elements from those 30 applicants, if they elect to participate in a PMR/F program designed for fellows who retain their existing employment in a state, tribal, local, and territorial (STLT) agency and conduct training-in-place.
Authorizing Statute(s):
US Code:
42 USC 301
Name of Law: Public Health Service Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
79 FR 57557
09/25/2014
30-day Notice:
Federal Register Citation:
Citation Date:
79 FR 71103
12/01/2014
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
4
IC Title
Form No.
Form Name
2014 FMS Alumni Directory - EIS Alumni Directory Example
2014 FMS Application Module - EIS Application Example
NA
FMS Application Module
2014 FMS Host Site Module - PHAP Host Site Example
NA
FMS Host Site Module
PMR/F Fellowship Applicants
0920-0765
Attachment_2-Original FMS_Application_Module
ICR Summary 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
3,781
3,751
0
30
0
0
Annual Time Burden (Hours)
4,450
4,390
0
60
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
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:
The purpose of this change request is for OMB approval of proposed modifications to accommodate changing needs of the fellowship program that reflect evolving fellowship eligibility requirements. Specifically, this change request will support collection of previously identified data elements from an estimated 30 new respondents who are nonfederal applicants to PMR/F in the FMS application module. It will also collect limited new data elements from those 30 applicants
Annual Cost to Federal Government:
$1,056,000
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
Yes
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?
Uncollected
Agency Contact:
Catina Conner 404 639-4775
Common Form ICR:
No
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:
03/23/2017
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