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

ICR 202402-0906-004

OMB: 0906-0084

Federal Form Document

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0906-0084 can be found here:

2024-06-28 - No material or nonsubstantive change to a currently approved collection

Forms and Documents

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

IC Document Collections

IC ID	Document Title	Status
265734	MIECHV TARC Satisfaction Survey Form and Instruction	New
265672	DIR Objective Review Assessment Survey Instruction	New
265627	Federal Cervical Cancer Collaborative (FCCC) CERV-Net Evaluation Form and Instruction	New
265626	Collection of Qualitative Feedback on Telehealth.HHS.gov Form	New
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