2019 Reader Feedback: Brush Up on Oral Health

Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery

2019 Reader Feedback Form-6-24-19

2019 Reader Feedback: Brush Up on Oral Health

OMB: 0970-0401

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O MB #: 0970-0401

Expiration Date: 5/31/2021





2019 Reader Feedback: Brush Up on Oral Health


Brush Up on Oral Health (BUOH) is a monthly tip sheet designed to provide Head Start staff and others with information on current practice and practical tips to promote good oral health. Please tell us what you think about BUOH and how you use it. We also want to know about what topics you would like to learn more about and your ideas on how to improve the tip sheet.


  1. Have you used the information on Brush Up on Oral Health?

Yes

No


  1. If yes, check all that apply

Personal education

Information shared with Head Start staff (for example, at staff trainings, in newsletter, at meetings)

Ideas for classroom activity

Developed/updated program policy

Prepared a recipe

Other (please specify)





  1. Has the information in the tip sheet lead to a policy or program change?

Yes

No


  1. If yes, please describe.





  1. Have you accessed educational materials (clicked links) in the tip sheet?

Yes

No


  1. If yes, have you shared any of the educational materials in English with families?

Yes

No


  1. If yes, have you shared any of the educational materials in Spanish with families?

Yes

No




  1. Have you shared the tip sheet with others?

Yes

No


  1. If yes, check all that apply.

Head Start program director

Head Start family service coordinator

Head Start health manager

Head Start home visitor

Head Start teacher

Head Start state collaboration office staff

State Head Start association staff

WIC program staff

Child care provider

Dental provider and office staff

Pediatrician and office staff

Other (please specify)




  1. How many people do you send the tip sheet to each month?

1–10

11–25

26–99

100 or more


  1. What topics would you like to see addressed in the tip sheet in the future?





  1. What suggestions do you have for improving the tip sheet?





  1. What is the state or territory where you work?

State:


  1. What is your position?

Dental hygienist liaison

Head Start program director

Head Start family service coordinator

Head Start health manager

Head Start home visitor

Head Start program manager

Head Start teacher

Oral health program administrator

Oral health provider

Other (please specify)





  1. If you work with Head Start, what type of program are you affiliated with? Check all that apply.

Early Head Start home-based

Early Head Start center-based

Head Start

American Indian/Alaska Native Head Start

Migrant and Seasonal Head Start

Paperwork Reduction Act Burden Statement: This collection of information is voluntary. Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. 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.

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AuthorMicrosoft Office User
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