OMB No: 0915-0212
Expiration date: 07/31/2021
HV-ImpACT Targeted TA & Project Officer 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 .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 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.
Please indicate the role with which you most closely identify.
MIECHV Program Manager / Project Supervisor
Home Visiting Resource Coordinator
Home Visiting Program Manager
Data Manager / CQI Specialist
Public Health Analyst
Other, please explain:______
Overall, how satisfied were you with the (targeted technical assistance request/delivery of the targeted technical assistance)?
Extremely satisfied
Satisfied
Somewhat satisfied
Somewhat dissatisfied
Dissatisfied
Extremely dissatisfied
[If respondent chooses “somewhat dissatisfied,” “Dissatisfied,” or “Extremely dissatisfied” in #2] Please explain why you were dissatisfied with the technical assistance. (Open-ended text entry)
How helpful was the content provided by (your/the) TA Specialist in addressing (your/the awardee’s) TA needs?
Extremely helpful
Very helpful
Moderately helpful
Slightly helpful
Not at all helpful
[If respondent chooses “Moderately helpful,” “Slightly helpful,” or “Not at all helpful” in #4] How could (your TA Specialist’s/HV-ImpACT’s) technical assistance have been more helpful in addressing (your/ the awardee’s) TA needs? (Open-ended text entry)
Please tell us the extent to which you agree or disagree with the following statements about resources.
The targeted technical assistance connected (me/the awardee)… |
1 = Strongly agree; 2 = Agree; 3 = Somewhat agree; 4 = Somewhat disagree; 5 = Disagree; 6 = Strongly disagree |
a. With HV-ImpACT resources. |
1 2 3 4 5 6 |
b. With other useful resources. |
1 2 3 4 5 6 |
Have you taken any action steps as a result of this targeted TA request? [For awardees only]
Yes
No
[If the respondent chooses “Yes” in response to Question #7] Please describe 1-2 action steps you have taken this year as a result of the targeted TA request. (Open-ended text entry)
[If the respondent chooses “No” in response to Question #7] Please describe how the technical assistance could have better supported you in taking action steps. (Open-ended text entry)
Overall, how satisfied were you with the following items regarding (your/the) TA Specialist?
|
1 = Extremely satisfied; 2 = Satisfied; 3 = Somewhat satisfied; 4 = Somewhat dissatisfied; 5 = Dissatisfied; 6 = Extremely dissatisfied |
a. The responsiveness of (my/the) TA Specialist. |
1 2 3 4 5 6 |
b. The communication with (my/the) TA Specialist. |
1 2 3 4 5 6 |
c. (My/the) TA Specialist’s ability to understand the unique nature of (my/the awardee’s) needs. |
1 2 3 4 5 6 |
d. (My/the) TA Specialist’s knowledge of the technical assistance topics. |
1 2 3 4 5 6 |
Please indicate the extent to which you agree or disagree with the following statements about performance measures.
The targeted technical assistance supported (our/the awardee’s) improved performance on… |
1 = Strongly agree; 2 = Agree; 3 = Somewhat agree; 4 = Somewhat disagree; 5 = Disagree; 6 = Strongly disagree |
a. Performance measures |
1 2 3 4 5 6 |
b. Staff recruitment and retention |
1 2 3 4 5 6 |
c. Place-based services |
1 2 3 4 5 6 |
d. Family engagement |
1 2 3 4 5 6 |
e. Program capacity |
1 2 3 4 5 6 |
What aspect of the targeted TA request was most useful? (Open-ended text entry)
In what ways could your TA Specialist better support (you/awardees) in future targeted TA requests? (Open-ended text entry)
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| Author | McAuley, Emma |
| File Modified | 0000-00-00 |
| File Created | 2021-01-13 |