OMB No: 0915-0212
Expiration date: 07/31/2021
HV-ImpACT Newsletter 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.
What is your state/territory?
Drop-down of all states and territories, including “N/A” option
How have you accessed a Home Visiting Home Run newsletter? Please check all that apply.
Through my email
Through the MIECHV Awardee Portal (MAP)
A colleague forwarded it
Other, please explain:_____________
I have not accessed a Home Visiting Home Run newsletter [If selected, respondent skipped to end of survey]
Overall, how satisfied are you with the Home Visiting Home Run newsletter?
Extremely Satisfied
Satisfied
Somewhat Satisfied
Somewhat Dissatisfied
Dissatisfied
Extremely Dissatisfied
[If respondent chooses “Somewhat dissatisfied,” “Dissatisfied,” or “Strongly dissatisfied” on Question #3] Please explain why you were dissatisfied with the Home Visiting Home Run newsletter. (Open-ended text entry)
Please tell us the extent to which you agree or disagree with the following statements.
The Home Visiting Home Run newsletter… |
1 = Strongly agree; 2 = Agree; 3 = Somewhat agree; 4 = Somewhat disagree; 5 = Disagree; 6 = Strongly disagree |
a. Enhanced my organization’s ability to reach our performance measures. |
1 2 3 4 5 6 |
b. Addressed a technical assistance need I have. |
1 2 3 4 5 6 |
c. Connected me with useful resources. |
1 2 3 4 5 6 |
[If respondent chooses “Somewhat disagree,” “Disagree,” or “Strongly disagree” on Question #5] Please explain how the Home Visiting Home Run newsletter could better support you. (Open-ended text entry)
What aspects of the Home Visiting Home Run newsletter were most useful? (Open-ended text entry)
What can HV-ImpACT do to improve future Home Visiting Home Run newsletters? (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 |