D Attachment D - HV-PMCQI Webinar Survey

OMB No: 0915-0212

Expiration date: 07/31/2021

HV-PM/CQI TA Center Webinar 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.

1. Overall, how satisfied were you with the webinar?

• Extremely satisfied

• Satisfied

• Somewhat satisfied

• Somewhat dissatisfied

• Dissatisfied

• Extremely dissatisfied

2. [If respondent chooses options d-f in #1] Please explain why you were dissatisfied with the webinar. Open-ended text response

3. How helpful was the webinar content in addressing your technical assistance needs?

• Extremely helpful

• Very helpful

• Moderately helpful

• Slightly helpful

• Not at all helpful

4. [If respondent chooses options d-f in #3] Please explain how the webinar could have been more helpful. Open-ended text response

5. To what extent did this webinar improve your organization’s capacity in [insert topic]?

• Greatly improved capacity

• Moderately improved capacity

• Slightly improved capacity

• Did not improve capacity

6. What aspects of the webinar were most useful? Open-ended text response

7. What can we do to improve future webinars? Open-ended text response

8. What is your project role?

• MIECHV awardee

• Other, please explain:______

9. What is your state/territory?

   1. Dropdown list of all 56 awardees/territories, plus N/A option