OMB Control Number: 0915-0212
Expiration Date: 05/31/2018
Newsletter/Issue Brief/MIECHV Groupsite Customer Satisfaction Survey
Please fill out this brief survey and tell us about the HV-ImpACT Home Visiting Home Run newsletters, Home Visiting Issues and Insights issue briefs, and the MIECHV Groupsite.
Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0915-0212. Public reporting burden for this collection of information is estimated to average 0.12 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspects of this collection of information, including suggestions for reducing burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 10-29, Rockville, MD, 20857.
Section 1
Listed below are three technical assistance resources that the HV-ImpACT provides. Please select all of the resources you have accessed in the past 3 months. (Check all that apply.) Note: Respondents will be directed to complete Section 2 for each of the responses checked.
Home Visiting Home Run newsletters
Home Visiting Issues and Insights issue briefs
MIECHV Groupsite
None of the above
Section 2
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Strongly agree |
Somewhat agree
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Neither agree nor disagree |
Somewhat disagree |
Strongly disagree |
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Strongly agree |
Somewhat agree
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Neither agree nor disagree |
Somewhat disagree |
Strongly disagree |
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Strongly agree |
Somewhat agree
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Neither agree nor disagree |
Somewhat disagree |
Strongly disagree |
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Strongly agree |
Somewhat agree
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Neither agree nor disagree |
Somewhat disagree |
Strongly disagree |
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Extremely satisfied |
Somewhat satisfied |
Neither satisfied nor dissatisfied |
Somewhat dissatisfied |
Extremely dissatisfied |
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Extremely satisfied |
Somewhat satisfied |
Neither satisfied nor dissatisfied |
Somewhat dissatisfied |
Extremely dissatisfied |
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Extremely satisfied |
Somewhat satisfied |
Neither satisfied nor dissatisfied |
Somewhat dissatisfied |
Extremely dissatisfied |
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Strongly agree |
Somewhat agree
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Neither agree nor disagree |
Somewhat disagree |
Strongly disagree |
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Strongly agree |
Somewhat agree
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Neither agree nor disagree |
Somewhat disagree |
Strongly disagree |
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Strongly agree |
Somewhat agree
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Neither agree nor disagree |
Somewhat disagree |
Strongly disagree |
(Open-ended) What can we do to improve (future newsletters/future issue briefs/the MIECHV Groupsite)?
Section 3 (All respondents who indicated they have accessed the newsletter, issue brief, and/or MIECHV Groupsite in the past 3 months.)
(Open-ended) What topics or subjects would you like us to address in future newsletters and issue briefs?
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | McAuley, Emma |
File Modified | 0000-00-00 |
File Created | 2021-01-22 |