Information Collection

MIECHV TARC Satisfaction Survey

IC 265734 under ICR 202402-0906-004 · OMB 0906-0084.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 MIECHV TARC Satisfaction Survey	Form and Instruction
1 Adaptive Leadership Academy Completion Survey Adaptive Leadership Academy Completion Survey.docx	Form and Instruction
2 Community of Practice Survey Completion Survey Community of Practice Survey_Completion Survey.docx	Form and Instruction
3 Practicum Check In Survey CQI Practicum Check in Survey.docx	Form and Instruction
4 CQI Practicum Polls CQI Practicum Polls.docx	Form and Instruction
5 Individualized Targeted TA Check in Individualized Targeted TA Check in.docx	Form and Instruction
6 Small Group TA Closeout Survey Small Group TA Closeout Survey.docx	Form and Instruction
7 TARC Meeting Poll TARC Meeting Poll.docx	Form and Instruction
9 Webinar Survey Webinar Survey.docx	Form and Instruction
8 CQI Practicum Completion Survey CQI Practicum Completion Survey.docx	Form and Instruction
10 Individualized Targeted TA Individualized Targeted TA Closeout.docx	Form and Instruction
Fast track memo_TARC Surveys.docx MIECHV TARC Fast Track Survey Memo	IC Document

IC Title:

MIECHV TARC Satisfaction Survey

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Adaptive Leadership Academy Completion Survey	Adaptive Leadership Academy Completion Survey.docx	Yes	Yes	Fillable Fileable
Form and Instruction	2	Community of Practice Survey Completion Survey	Community of Practice Survey_Completion Survey.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	Practicum Check In Survey	CQI Practicum Check in Survey.docx	Yes	Yes	Fillable Fileable
Form and Instruction	4	CQI Practicum Polls	CQI Practicum Polls.docx	Yes	Yes	Fillable Fileable
Form and Instruction	5	Individualized Targeted TA Check in	Individualized Targeted TA Check in.docx	Yes	Yes	Fillable Fileable
Form and Instruction	6	Small Group TA Closeout Survey	Small Group TA Closeout Survey.docx	Yes	Yes	Fillable Fileable
Form and Instruction	7	TARC Meeting Poll	TARC Meeting Poll.docx	Yes	Yes	Fillable Fileable
Form and Instruction	9	Webinar Survey	Webinar Survey.docx	Yes	Yes	Fillable Fileable
Form and Instruction	8	CQI Practicum Completion Survey	CQI Practicum Completion Survey.docx	Yes	Yes	Fillable Fileable
Form and Instruction	10	Individualized Targeted TA	Individualized Targeted TA Closeout.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 967

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	967	967
Annual IC Time Burden (Hours)	145	145
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
MIECHV TARC Fast Track Survey Memo	Fast track memo_TARC Surveys.docx	03/04/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.