Maternal, Infant, and Early Childhood Home Visiting Program HV-PM/CQI Technical Assistance Center Satisfaction Surveys

Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

OMB: 0915-0212

IC ID: 232942

Information Collection (IC) Details

View Information Collection (IC)

Maternal, Infant, and Early Childhood Home Visiting Program HV-PM/CQI Technical Assistance Center Satisfaction Surveys
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form A Attachment A - HV-PMCQI Annual Survey.docx Attachment A - HV-PMCQI Annual Survey.docx Yes Yes Fillable Fileable
Form B Attachment B - HV-PMCQI Information Request Survey.docx Attachment B - HV-PMCQI Information Request Survey.docx Yes Yes Fillable Fileable
Form C Attachment C - HV-PMCQI Individualized TA Survey.docx Attachment C - HV-PMCQI Individualized TA Survey.docx Yes Yes Fillable Fileable
Form D Attachment D - HV-PMCQI Webinar Survey.docx Attachment D - HV-PMCQI Webinar Survey.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,150 0
   
State, Local, and Tribal Governments
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,150 0 0 0 0 1,150
Annual IC Time Burden (Hours) 112 0 0 0 0 112
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement A Supporting Statement DHVECS HV-PMCQI Surveys_2018_FINAL.docx 09/07/2018
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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