Partnership Meeting Questionnaire

Form Approved

OMB No. 0990-0391

Exp. Date 05/31/2018

HPP Partnership Meeting Follow Up Survey

1. Please provide your name and organization

_________________________________________________________________________________________________________________________________________________________________________________________________________

2. How frequently would you like the HPP Partnership Meetings to occur? (multiple choice)

   1. Every other month

   2. Quarterly

   3. Other: ___________________

3. What is your preferred length for the HPP Partnership meetings? (multiple choice)

   1. 2 hours

   2. 3 hours

   3. Other: ___________________

4. What topics would you like to suggest for future HPP Partnership Meetings?

_________________________________________________________________________________________________________________________________________________________________________________________________________

5. Would you or your organization like to present at an upcoming HPP Partnership Meeting? If yes, please include potential topic and contact information for follow up and coordination.

   1. Yes. ________________________________________________________________________________________________________________________________

   2. No

6. Please provide us with any improvements or changes would you see to the HPP Partnership Meetings (i.e. length of meeting, content, method of outreach)

_________________________________________________________________________________________________________________________________________________________________________________________________________

7. Please list any additional organizations that you think would be interested in attending these partnership meetings.

_________________________________________________________________________________________________________________________________________________________________________________________________________

8. Would you and your organization like to part of the HPP Partnership Meeting series moving forward?

   1. Yes

   2. No

9. Would you like to be part of a distribution list for periodic/ad-hoc updates from HPP? If yes, please provide your contact information.

   1. Yes

________________________________________________________________________________________________________________________________________________________________________________________________

2. No

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0391. The time required to complete this information collection is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer