3 Post Learning Collaborative Survey

OMB No: 0915-0212

Expiration date: 04/30/2024

Post Learning Collaborative 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 0.08 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. How satisfied are/were you with [title] Learning Collaborative (LC)?

   1. Extremely satisfied

   2. Satisfied

   3. Dissatisfied

   4. Extremely dissatisfied

2. [If chosen “Dissatisfied” or “Extremely dissatisfied”] Please explain why you are/were dissatisfied with the LC: [Open text]

3. Will you take any action steps as a result of your participation in this LC?

   1. Yes

   2. No

4. [If yes] Please describe 1-2 action steps you plan to take as a result of your participation in this LC: [Open text]

5. [If no] Please describe how the LC could better support you/could have better supported you in taking action steps: [Open text]

6. What is the most pressing topic you would like to discuss during the next LC? [Open text]

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