Information Collection Request

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

ICR 202401-0915-004 · OMB 0915-0212 · Received in OIRA

Forms and Documents

Document	Type	Status	Availability
Form 1 HRSA Web Survey	Form	New	Repair queued
Form 1 Title V Information System User Satisfaction Survey	Form and Instruction	New	Repair queued
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form	New	Repair queued
Form 1 Collection of Qualitative Feedback on Telehealth.HHS.gov	Form and Instruction	New	Repair queued
Form 1 National Practitioner Data Bank Usability Survey	Form and Instruction	New	Repair queued
Form 1 Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms	Form and Instruction	New	Repair queued
Form 1 National Marrow Donor Program Donation Experience Survey	Form and Instruction	New	Repair queued
Form 1 Maternal, Infant, and Early Childhood Home Visiting Site Visit Awardee Feedback Form	Form and Instruction	New	Repair queued
Form 1 Maternal, Infant, and Early Childhood Home Visiting Program On-Site Compliance Review Awardee Feedback Form	Form	New	Repair queued
Form 1 2024 Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Evaluation Surveys	Form	New	Repair queued
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form	New	Repair queued
Form 1 Health Center Program Support Customer Service Survey	Form and Instruction	New	Repair queued
Form 1 HRSA Electronic Handbooks Customer Service Survey	Form and Instruction	New	Repair queued
Form A Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys	Form and Instruction	New	Repair queued
Form 1.1 Division of Independent Review Objective Review Assessment Survey	Form and Instruction	New	Repair queued
Form 1 Division of Grants Management Operations Customer Service Satisfaction Survey	Form	New	Repair queued
Focus Group Example_Screening Questions.docx	Supplementary Document	Uploaded 2024-01-09	Repair queued
Focus Group Example_Informed Consent.docx	Supplementary Document	Uploaded 2024-01-09	Missing upstream
Focus Group Example_Focus Group Guide.docx	Supplementary Document	Uploaded 2024-01-09	Repair queued
Supporting Statement B 12.8.23.docx	Supporting Statement B	Uploaded 2024-01-09	Repair queued
Supporting Statement A 12.8.23.docx	Supporting Statement A	Uploaded 2024-01-09	Repair queued

IC Document Collections

IC ID	Collection	Type	Status
264362	HRSA Web Survey	Form	New
264361	Title V Information System User Satisfaction Survey	Form and Instruction	New
264360	Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form	New
264359	Tree Testing of HRSA's Ryan White HIV/AIDS Program website	Other-Tree Test Plan	New
264357	Collection of Qualitative Feedback on Telehealth.HHS.gov	Form and Instruction	New
264355	National Practitioner Data Bank Usability Survey	Form and Instruction	New
264354	Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms	Form and Instruction	New
264353	National Marrow Donor Program Donation Experience Survey	Form and Instruction	New
264352	Maternal, Infant, and Early Childhood Home Visiting Site Visit Awardee Feedback Form	Form and Instruction	New
264351	Maternal, Infant, and Early Childhood Home Visiting Program On-Site Compliance Review Awardee Feedback Form	Form	New
264349	2024 Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Evaluation Surveys	Form	New
264348	Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form	New
264347	Health Center Program Support Customer Service Survey	Form and Instruction	New
264346	HRSA Electronic Handbooks Customer Service Survey	Form and Instruction	New
264345	Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys	Form and Instruction	New
264344	Division of Independent Review Objective Review Assessment Survey	Form and Instruction	New
264342	Division of Grants Management Operations Customer Service Satisfaction Survey	Form	New

ICR Details

Status	Received in OIRA
Agency/Subagency	HHS/HSA
OMB Control No	0915-0212
Type of Information Collection	Revision of a currently approved collection
Previous ICR Reference No	202401-0915-001
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31