OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 202503-0906-002 · OMB 0906-0084 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 1 Follow up: ASPR/ Strategic National Stockpile (SNS) Dissemination and HRSA-Supported Health Centers use of JYNNEOS vaccine. Form Unchanged Repair queued
Form 1 Follow up: ASPR/ Strategic National Stockpile (SNS) Dissemination and HRSA-Supported Health Centers use of JYNNEOS vaccine. Form Unchanged Repair queued
Form 1 Expanding Health Center Awareness of Sexual Assault-Related Health Care Needs (SATA) Evaluation Form and Instruction Unchanged Repair queued
Form 1 Expanding Health Center Awareness of Sexual Assault-Related Health Care Needs (SATA) Evaluation Form and Instruction Unchanged Repair queued
Form 1 HRSA/HIV & AIDS Bureau (HAB) Recipients Satisfaction Survey (RSS). Form and Instruction Unchanged Available
Form 1 HRSA/HIV & AIDS Bureau (HAB) Recipients Satisfaction Survey (RSS). Form and Instruction Unchanged Repair queued
Form 1 Division of Practitioner Data Bank (DPDB) Webinar Feedback and Satisfaction Surveys Form Unchanged Repair queued
Form 1 Division of Practitioner Data Bank (DPDB) Webinar Feedback and Satisfaction Surveys Form Unchanged Repair queued
Form 1 BPHC Customer Service Survey Form and Instruction Unchanged Available
Form 1 BPHC Customer Service Survey Form and Instruction Unchanged Repair queued
Form 2 2024 National Ryan White Conference on HIV Care & Treatment Evaluation Form Unchanged Repair queued
Form 2 2024 National Ryan White Conference on HIV Care & Treatment Evaluation Form Unchanged Repair queued
Form 1 HRSA Web Survey Form Unchanged Repair queued
Form 1 HRSA Web Survey Form Unchanged Repair queued
Form 1 MIECHV TARC Satisfaction Survey Form and Instruction Unchanged Repair queued
Form 1 MIECHV TARC Satisfaction Survey Form and Instruction Unchanged Repair queued
Form 1 Federal Cervical Cancer Collaborative (FCCC) CERV-Net Evaluation Form and Instruction Unchanged Repair queued
Form 1 Federal Cervical Cancer Collaborative (FCCC) CERV-Net Evaluation Form and Instruction Unchanged Repair queued
Form 1 Collection of Qualitative Feedback on Telehealth.HHS.gov Form Unchanged Repair queued
Form 1 Collection of Qualitative Feedback on Telehealth.HHS.gov Form Unchanged Repair queued
Form 1 HRSA Web Survey Form Unchanged Repair queued
Form 1 HRSA Web Survey Form Unchanged Repair queued
Form 1 Title V Information System User Satisfaction Survey Form and Instruction Unchanged Repair queued
Form 1 Title V Information System User Satisfaction Survey Form and Instruction Unchanged Repair queued
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form Unchanged Repair queued
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form Unchanged Repair queued
Form 1 Collection of Qualitative Feedback on Telehealth.HHS.gov Form and Instruction Unchanged Available
Form 1 Collection of Qualitative Feedback on Telehealth.HHS.gov Form and Instruction Unchanged Repair queued
Form 1 National Practitioner Data Bank Usability Survey Form and Instruction Unchanged Available
Form 1 National Practitioner Data Bank Usability Survey Form and Instruction Unchanged 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 Unchanged Available
Form 1 Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction Unchanged Repair queued
Form 1 National Marrow Donor Program Donation Experience Survey Form and Instruction Unchanged Repair queued
Form 1 National Marrow Donor Program Donation Experience Survey Form and Instruction Unchanged Repair queued
Form 1 Maternal, Infant, and Early Childhood Home Visiting Site Visit Awardee Feedback Form Form and Instruction Unchanged Repair queued
Form 1 Maternal, Infant, and Early Childhood Home Visiting Site Visit Awardee Feedback Form Form and Instruction Unchanged Repair queued
Form 1 Maternal, Infant, and Early Childhood Home Visiting Program On-Site Compliance Review Awardee Feedback Form Form Unchanged Repair queued
Form 1 Maternal, Infant, and Early Childhood Home Visiting Program On-Site Compliance Review Awardee Feedback Form Form Unchanged Repair queued
Form 1 2024 Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Evaluation Surveys Form Unchanged Repair queued
Form 1 2024 Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Evaluation Surveys Form Unchanged Repair queued
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form Unchanged Repair queued
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form Unchanged Repair queued
Form 1 Health Center Program Support Customer Service Survey Form and Instruction Unchanged Available
Form 1 Health Center Program Support Customer Service Survey Form and Instruction Unchanged Repair queued
Form 1 HRSA Electronic Handbooks Customer Service Survey Form and Instruction Unchanged Repair queued
Form 1 HRSA Electronic Handbooks Customer Service Survey Form and Instruction Unchanged Repair queued
Form A Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys Form and Instruction Unchanged Repair queued
Form A Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys Form and Instruction Unchanged Repair queued
Form 1.1 Division of Independent Review Objective Review Assessment Survey Form and Instruction Unchanged Repair queued
Form 1.1 Division of Independent Review Objective Review Assessment Survey Form and Instruction Unchanged Repair queued
Form 1 Division of Grants Management Operations Customer Service Satisfaction Survey Form Unchanged Repair queued
Form 1 Division of Grants Management Operations Customer Service Satisfaction Survey Form Unchanged Repair queued
0906-0084_MCHB_OMB NonSubstantive Change Request_03052025.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-03-14 Available
0906-0084_MCHB_OMB NonSubstantive Change Request_03052025.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-03-14 Repair queued
0906 0084_NSC Memo.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-06-28 Available
0906 0084_NSC Memo.docx Justification for No Material/Nonsubstantive Change Uploaded 2024-06-28 Repair queued
Focus Group Example_Screening Questions.docx Supplementary Document Uploaded 2024-01-09 Available
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 Repair queued
Focus Group Example_Informed Consent.docx Supplementary Document Uploaded 2024-01-09 Repair queued
Focus Group Example_Focus Group Guide.docx Supplementary Document Uploaded 2024-01-09 Available
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 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 Available
Supporting Statement A 12.8.23.docx Supporting Statement A Uploaded 2024-01-09 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
271634 Follow up: ASPR/ Strategic National Stockpile (SNS) Dissemination and HRSA-Supported Health Centers use of JYNNEOS vaccine. Form Unchanged
271634 Follow up: ASPR/ Strategic National Stockpile (SNS) Dissemination and HRSA-Supported Health Centers use of JYNNEOS vaccine. Form Unchanged
271017 National Maternal Mental Health Hotline Instruction Modified
270921 Expanding Health Center Awareness of Sexual Assault-Related Health Care Needs (SATA) Evaluation Form and Instruction Unchanged
270921 Expanding Health Center Awareness of Sexual Assault-Related Health Care Needs (SATA) Evaluation Form and Instruction Unchanged
268809 Technical Assistance to Support the HHS Viral Hepatitis National Strategic Plan Other-Interview Questions Unchanged
267884 HRSA/HIV & AIDS Bureau (HAB) Recipients Satisfaction Survey (RSS). Form and Instruction Unchanged
267884 HRSA/HIV & AIDS Bureau (HAB) Recipients Satisfaction Survey (RSS). Form and Instruction Unchanged
267569 Division of Practitioner Data Bank (DPDB) Webinar Feedback and Satisfaction Surveys Form Unchanged
267569 Division of Practitioner Data Bank (DPDB) Webinar Feedback and Satisfaction Surveys Form Unchanged
266289 BPHC Customer Service Survey Form and Instruction Unchanged
266289 BPHC Customer Service Survey Form and Instruction Unchanged
266140 2024 National Ryan White Conference on HIV Care & Treatment Evaluation Form Unchanged
266140 2024 National Ryan White Conference on HIV Care & Treatment Evaluation Form Unchanged
266005 HRSA Web Survey Form Unchanged
266005 HRSA Web Survey Form Unchanged
265734 MIECHV TARC Satisfaction Survey Form and Instruction Unchanged
265734 MIECHV TARC Satisfaction Survey Form and Instruction Unchanged
265672 DIR Objective Review Assessment Survey Instruction Unchanged
265627 Federal Cervical Cancer Collaborative (FCCC) CERV-Net Evaluation Form and Instruction Unchanged
265627 Federal Cervical Cancer Collaborative (FCCC) CERV-Net Evaluation Form and Instruction Unchanged
265626 Collection of Qualitative Feedback on Telehealth.HHS.gov Form Unchanged
265626 Collection of Qualitative Feedback on Telehealth.HHS.gov Form Unchanged
264362 HRSA Web Survey Form Unchanged
264362 HRSA Web Survey Form Unchanged
264361 Title V Information System User Satisfaction Survey Form and Instruction Unchanged
264361 Title V Information System User Satisfaction Survey Form and Instruction Unchanged
264360 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form Unchanged
264360 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form Unchanged
264359 Tree Testing of HRSA's Ryan White HIV/AIDS Program website Other-Tree Test Plan Unchanged
264357 Collection of Qualitative Feedback on Telehealth.HHS.gov Form and Instruction Unchanged
264357 Collection of Qualitative Feedback on Telehealth.HHS.gov Form and Instruction Unchanged
264355 National Practitioner Data Bank Usability Survey Form and Instruction Unchanged
264355 National Practitioner Data Bank Usability Survey Form and Instruction Unchanged
264354 Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction Unchanged
264354 Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction Unchanged
264353 National Marrow Donor Program Donation Experience Survey Form and Instruction Unchanged
264353 National Marrow Donor Program Donation Experience Survey Form and Instruction Unchanged
264352 Maternal, Infant, and Early Childhood Home Visiting Site Visit Awardee Feedback Form Form and Instruction Unchanged
264352 Maternal, Infant, and Early Childhood Home Visiting Site Visit Awardee Feedback Form Form and Instruction Unchanged
264351 Maternal, Infant, and Early Childhood Home Visiting Program On-Site Compliance Review Awardee Feedback Form Form Unchanged
264351 Maternal, Infant, and Early Childhood Home Visiting Program On-Site Compliance Review Awardee Feedback Form Form Unchanged
264349 2024 Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Evaluation Surveys Form Unchanged
264349 2024 Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Evaluation Surveys Form Unchanged
264348 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form Unchanged
264348 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form Unchanged
264347 Health Center Program Support Customer Service Survey Form and Instruction Unchanged
264347 Health Center Program Support Customer Service Survey Form and Instruction Unchanged
264346 HRSA Electronic Handbooks Customer Service Survey Form and Instruction Unchanged
264346 HRSA Electronic Handbooks Customer Service Survey Form and Instruction Unchanged
264345 Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys Form and Instruction Unchanged
264345 Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys Form and Instruction Unchanged
264344 Division of Independent Review Objective Review Assessment Survey Form and Instruction Unchanged
264344 Division of Independent Review Objective Review Assessment Survey Form and Instruction Unchanged
264342 Division of Grants Management Operations Customer Service Satisfaction Survey Form Unchanged
264342 Division of Grants Management Operations Customer Service Satisfaction Survey Form Unchanged
ICR Details
StatusActive
Agency/SubagencyHHS/HRSA
OMB Control No0906-0084
Type of Information CollectionNo material or nonsubstantive change to a currently approved collection
Previous ICR Reference No202406-0906-005
Date Submitted to OIRA2025-03-28
Requested Expiration Date1969-12-31