OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 202401-0915-001 · OMB 0915-0212 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 1 Evaluation Survey of Eligible National Practitioner Data Bank (NPDB) Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction Unchanged Available
Form 1 Evaluation Survey of Eligible National Practitioner Data Bank (NPDB) Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction Unchanged Repair queued
Form 1 2024 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program All Grantee Meeting Evaluation Surveys Form Unchanged Available
Form 1 2024 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program All Grantee Meeting Evaluation Surveys Form Unchanged Repair queued
Form 1 National Practitioner Data Bank (NPDB) Usability Survey Form and Instruction Unchanged Repair queued
Form 1 National Practitioner Data Bank (NPDB) Usability Survey Form and Instruction Unchanged Repair queued
Form 1 Trainee Ambassador Group Survey Form and Instruction Unchanged Available
Form 1 Trainee Ambassador Group Survey Form and Instruction Unchanged Repair queued
Form 1 HRSA Web Survey Form Unchanged Available
Form 1 HRSA Web Survey Form Unchanged Repair queued
Form 1 Customer Feedback Survey Form and Instruction Unchanged Available
Form 1 Customer Feedback Survey Form and Instruction Unchanged Repair queued
Form 1 Listening Session Questions Form and Instruction Unchanged Repair queued
Form 1 Listening Session Questions Form and Instruction Unchanged Repair queued
Form 1 Primary Health Care Digest Newsletter Subscriber Survey Form and Instruction Unchanged Repair queued
Form 1 Primary Health Care Digest Newsletter Subscriber Survey Form and Instruction Unchanged Repair queued
Form 1 Tree Testing of HRSA's Ryan White HIV/AIDS Program website Form and Instruction Unchanged Repair queued
Form 1 Tree Testing of HRSA's Ryan White HIV/AIDS Program website Form and Instruction Unchanged Repair queued
Form 1 HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach (Online Focus Groups) Form and Instruction Unchanged Available
Form 1 HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach (Online Focus Groups) Form and Instruction Unchanged Repair queued
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center (ITAC) Satisfaction Surveys Form Unchanged Available
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center (ITAC) Satisfaction Surveys Form Unchanged Repair queued
Form 1 2022 National Ryan White Conference on HIV Care & Treatment Evaluation Form and Instruction Unchanged Repair queued
Form 1 2022 National Ryan White Conference on HIV Care & Treatment Evaluation Form and Instruction Unchanged Repair queued
Form 1 Be The Match Donation Experience Survey Form and Instruction Modified Available
Form 1 Be The Match Donation Experience Survey Form and Instruction Modified Repair queued
Form 1 Federal Cervical Cancer Collaborative (FCCC) Post-Roundtable Evaluation Form and Instruction Unchanged Available
Form 1 Federal Cervical Cancer Collaborative (FCCC) Post-Roundtable Evaluation Form and Instruction Unchanged Repair queued
Form A Early Childhood Systems Technical Assistance and Coordinating Center (ECS TACC) Customer Satisfaction Surveys Form Unchanged Available
Form A Early Childhood Systems Technical Assistance and Coordinating Center (ECS TACC) Customer Satisfaction Surveys Form Unchanged Repair queued
Form 1 MCH Nutrition Training Needs Assessment Form and Instruction Unchanged Available
Form 1 MCH Nutrition Training Needs Assessment Form and Instruction Unchanged Repair queued
Form 1 Organdonor.gov Website Survey Form and Instruction Unchanged Available
Form 1 Organdonor.gov Website Survey Form and Instruction Unchanged Repair queued
Form 1 DGMO Customer Service Satisfaction Survey Form Unchanged Available
Form 1 DGMO Customer Service Satisfaction Survey Form Unchanged Repair queued
Form 1 Health Center Program Support (HCPS) Customer Service Survey Form Unchanged Available
Form 1 Health Center Program Support (HCPS) Customer Service Survey Form Unchanged Repair queued
Form 1 Collection of Qualitative Feedback on Telehealth.HHS.gov Form Unchanged Available
Form 1 Collection of Qualitative Feedback on Telehealth.HHS.gov Form Unchanged Missing upstream
Form 1 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program On-Site Compliance Review Awardee Feedback Form Form Unchanged Available
Form 1 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program On-Site Compliance Review Awardee Feedback Form Form Unchanged Repair queued
Form 1 Title V Information System (TVIS) User Satisfaction Survey Form and Instruction Unchanged Available
Form 1 Title V Information System (TVIS) User Satisfaction Survey Form and Instruction Unchanged Repair queued
Form 1 Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys Form Unchanged Repair queued
Form 1 Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys Form Unchanged Repair queued
Form 1 HRSA Electronic Handbooks Customer Service Survey Form and Instruction Unchanged Available
Form 1 HRSA Electronic Handbooks Customer Service Survey Form and Instruction Unchanged Repair queued
12272023 - Memo to OMB - Non-Substantive Change Req.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-01-02 Available
12272023 - Memo to OMB - Non-Substantive Change Req.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-01-02 Repair queued
Introductory message from NPDB FINAL_For Clearance.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-12-14 Available
Introductory message from NPDB FINAL_For Clearance.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-12-14 Repair queued
NonSubstantive Change Request.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-12-14 Available
NonSubstantive Change Request.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-12-14 Repair queued
0915-0212_NSC Memo FINAL.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-08-17 Repair queued
0915-0212_NSC Memo FINAL.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-08-17 Repair queued
Supporting Statement - part B.docx Supporting Statement B Uploaded 2021-03-08 Available
Supporting Statement - part B.docx Supporting Statement B Uploaded 2021-03-08 Repair queued
Supporting Statement A FINAL.docx Supporting Statement A Uploaded 2021-03-08 Available
Supporting Statement A FINAL.docx Supporting Statement A Uploaded 2021-03-08 Repair queued
Example0212 focus.doc Supplementary Document Uploaded 2018-05-07 Available
Example0212 focus.doc Supplementary Document Uploaded 2018-05-07 Repair queued
Example Focus Group HSB.docx Supplementary Document Uploaded 2018-05-07 Available
Example Focus Group HSB.docx Supplementary Document Uploaded 2018-05-07 Repair queued
Example Customer Survey OFAM.pdf Supplementary Document Uploaded 2018-05-07 Available
Example Customer Survey OFAM.pdf Supplementary Document Uploaded 2018-05-07 Repair queued
Example Customer Survey BHW.pdf Supplementary Document Uploaded 2018-05-07 Available
Example Customer Survey BHW.pdf Supplementary Document Uploaded 2018-05-07 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
263816 Evaluation Survey of Eligible National Practitioner Data Bank (NPDB) Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction Unchanged
263816 Evaluation Survey of Eligible National Practitioner Data Bank (NPDB) Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction Unchanged
263615 2024 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program All Grantee Meeting Evaluation Surveys Form Unchanged
263615 2024 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program All Grantee Meeting Evaluation Surveys Form Unchanged
263052 National Practitioner Data Bank (NPDB) Usability Survey Form and Instruction Unchanged
263052 National Practitioner Data Bank (NPDB) Usability Survey Form and Instruction Unchanged
262807 Trainee Ambassador Group Survey Form and Instruction Unchanged
262807 Trainee Ambassador Group Survey Form and Instruction Unchanged
262607 National Organ Donation Expert Opinion Survey Instruction Unchanged
261675 HRSA Web Survey Form Unchanged
261675 HRSA Web Survey Form Unchanged
260381 Customer Feedback Survey Form and Instruction Unchanged
260381 Customer Feedback Survey Form and Instruction Unchanged
259969 Listening Session Questions Form and Instruction Unchanged
259969 Listening Session Questions Form and Instruction Unchanged
259876 Primary Health Care Digest Newsletter Subscriber Survey Form and Instruction Unchanged
259876 Primary Health Care Digest Newsletter Subscriber Survey Form and Instruction Unchanged
259711 Tree Testing of HRSA's Ryan White HIV/AIDS Program website Form and Instruction Unchanged
259711 Tree Testing of HRSA's Ryan White HIV/AIDS Program website Form and Instruction Unchanged
259277 Feedback and Lessons Learned from CBO Program Award Recipients Instruction Unchanged
259013 HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach (Online Focus Groups) Form and Instruction Unchanged
259013 HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach (Online Focus Groups) Form and Instruction Unchanged
258285 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center (ITAC) Satisfaction Surveys Form Unchanged
258285 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center (ITAC) Satisfaction Surveys Form Unchanged
254660 2022 National Ryan White Conference on HIV Care & Treatment Evaluation Form and Instruction Unchanged
254660 2022 National Ryan White Conference on HIV Care & Treatment Evaluation Form and Instruction Unchanged
253158 Health Center COVID-19 Vaccine Program (HCVP) After-Action Survey Instruction Unchanged
252323 Be The Match Donation Experience Survey Form and Instruction Modified
252323 Be The Match Donation Experience Survey Form and Instruction Modified
252068 Federal Cervical Cancer Collaborative (FCCC) Post-Roundtable Evaluation Form and Instruction Unchanged
252068 Federal Cervical Cancer Collaborative (FCCC) Post-Roundtable Evaluation Form and Instruction Unchanged
250631 Early Childhood Systems Technical Assistance and Coordinating Center (ECS TACC) Customer Satisfaction Surveys Form Unchanged
250631 Early Childhood Systems Technical Assistance and Coordinating Center (ECS TACC) Customer Satisfaction Surveys Form Unchanged
250357 MCH Nutrition Training Needs Assessment Form and Instruction Unchanged
250357 MCH Nutrition Training Needs Assessment Form and Instruction Unchanged
248953 Organdonor.gov Website Survey Form and Instruction Unchanged
248953 Organdonor.gov Website Survey Form and Instruction Unchanged
248753 DGMO Customer Service Satisfaction Survey Form Unchanged
248753 DGMO Customer Service Satisfaction Survey Form Unchanged
248514 Health Center Program Support (HCPS) Customer Service Survey Form Unchanged
248514 Health Center Program Support (HCPS) Customer Service Survey Form Unchanged
248260 Collection of Qualitative Feedback on Telehealth.HHS.gov Form Unchanged
248260 Collection of Qualitative Feedback on Telehealth.HHS.gov Form Unchanged
247769 DIR Objective Review Assessment Survey Instruction Unchanged
247472 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program On-Site Compliance Review Awardee Feedback Form Form Unchanged
247472 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program On-Site Compliance Review Awardee Feedback Form Form Unchanged
247059 Title V Information System (TVIS) User Satisfaction Survey Form and Instruction Unchanged
247059 Title V Information System (TVIS) User Satisfaction Survey Form and Instruction Unchanged
247043 Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys Form Unchanged
247043 Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys Form Unchanged
246973 HRSA Electronic Handbooks Customer Service Survey Form and Instruction Unchanged
246973 HRSA Electronic Handbooks Customer Service Survey Form and Instruction Unchanged
ICR Details
StatusActive
Agency/SubagencyHHS/HSA
OMB Control No0915-0212
Type of Information CollectionNo material or nonsubstantive change to a currently approved collection
Previous ICR Reference No202312-0915-001
Date Submitted to OIRA2024-01-04
Requested Expiration Date1969-12-31