TMIECHV Program Training and TA Immediate Feedback Form Gen. 7.10.24

Fast Track Generic Clearance for Collection of Qualitative Feedback on Agency Service Delivery

TMIECHV Program Training and TA Immediate Feedback Form Gen. 7.10.24

OMB: 0970-0401

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OMB Control No. 0970-0401

Expiration Date: 05/31/2027


Tribal Maternal, Infant, and Early Childhood Home Visiting Program Training and Technical Assistance Immediate Feedback Form

(administered after each Training or TA occurrence)

Shape1

Please select the role that most closely aligns with your responsibilities related to the Tribal Home Visiting project.


Grantee Lead/Director/Coordinator

Grantee Data/Evaluation Staff

Grantee Program Staff/Consultant


Grantee Grants Management/Fiscal Staff

Home Visitor

Shape7

Please rate items 1-6

TA met my needs

  1. This TA effectively met your needs.

  1. This TA provided productive ways of learning.


  1. This TA was engaging.

  1. TA on this topic was delivered at a time when it was relevant for your program.


  1. This TA met the intended goals/objectives.

  1. TA offered options for next steps, ideas, or action items that can be applied soon.



  1. TA facilitated new learning in the following areas:

  1. I am planning on applying what I learned in the following areas:

  1. Tribal/Organizational Leadership Support, Governance, and Administration

  1. Tribal/Organizational Leadership Support, Governance, and Administration

  1. Quality Workforce

  1. Quality Workforce

  1. Fidelity Monitoring / Model Fidelity

  1. Fidelity Monitoring / Model Fidelity

  1. Community and Partner Engagement

  1. Community and Partner Engagement

  1. Recruitment, Enrollment, and Engagement of Families

  1. Recruitment, Enrollment, and Engagement of Families

  1. Dissemination

  1. Dissemination

  1. Early Childhood Systems Building

  1. Early Childhood Systems Building

  1. Policies and Procedures

  1. Policies and Procedures

  1. Sustainability

  1. Sustainability

  1. Other topics (as applicable)

  1. Other topics (as applicable)

(7) Other feedback



PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13) STATEMENT OF PUBLIC BURDEN: Through this information collection, ACF is gathering information to assess the quality and outcomes of Training and Technical Assistance events. Public reporting burden for this collection of information is estimated to average 2 minutes per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The OMB # is 0970-0401, and the expiration date is 5/31/2027. If you have any comments on this collection of information, please contact Anne Bergan, Office of Early Childhood Development, Administration for Children and Families, HHS, Mary E. Switzer Building 330 C Street SW, Suite 3014F, Washington, DC 20024.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorTara Chico-Jarillo
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File Created2024-09-18

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