OMB No: 0915-0212
Expiration date: 07/31/2021
HV-PM/CQI TA Center Information Request Survey
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 .08 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 aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857.
How helpful was the content provided by your TA Specialist in addressing your technical assistance need(s)?
Extremely helpful
Very helpful
Moderately helpful
Slightly helpful
Not at all helpful
[If respondent chooses options c-f in #1] How could your TA Specialist’s technical assistance have been more helpful in addressing your needs with this request?
What is your state/territory?
Dropdown list of 56 states/territories plus an N/A option
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | McAuley, Emma |
| File Modified | 0000-00-00 |
| File Created | 2021-01-20 |