MIECHV TARC Satisfaction Survey

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

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

IC Title:	MIECHV TARC Satisfaction Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.