OMB control number

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

OMB 0915-0212 · HHS/HSA.

OMB 0915-0212

This generic project clearance allows HRSA to conduct voluntary customer satisfaction surveys of its partners to assess strengths and weaknesses in program services and products. Examples of such surveys include satisfaction with technical assistance provided to grantees, in class evaluations of training sessions, and satisfaction with information services.

The latest form for Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration expires 2021-07-31 and is listed under ICR 202012-0915-001.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form 2 Spanish Language Survey	Form
Form 1 English Language Survey	Form
Form 1 HRSA Web Survey	Form
Form 1 Screen Shots of Title V Information System Survey 2021	Form and Instruction
Form 1 Title V Information System User Satisfaction Survey	Form and Instruction
Form 10 CQI Practicum Completion Survey	Form
Form 9 Attachment I_CQI Practicum Check in Survey	Form
Form 8 Attachment H_Quarterly Overall TA Survey	Form
Form 7 Attachment G_Leadership Academy Completion Survey	Form
Form 6 Attachment F_Leadership Academy Session Survey	Form
Form 5 Attachment E_Community of Practice Survey	Form
Form 4 Attachment D_Webinar Survey	Form
Form 3 Attachment C_Project Officer Survey	Form
Form 2 Attachment B_Individualized Targeted TA Closeout	Form
Form 1 Attachment A_Individualized Targeted TA Check in	Form
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form
Form 1 Tree Test Script	Form
Form 2 Telehealth Website - Site Level - Survey EngSpan	Form and Instruction
Form 1 Telehealth Website - Page Level - SurveyEngSpan	Form and Instruction
Form 1 Collection of Qualitative Feedback on Telehealth.HHS.gov	Form and Instruction
Form 1 0915-0212_UsabiltyTesting Instrument_NPDBSystem	Form and Instruction
Form 1 National Practitioner Data Bank Usability Survey	Form and Instruction
Form 2 User Survey Questions - Query	Form and Instruction
Form 1 Query Survey Intro-Instructions	Form and Instruction
Form 1 Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms	Form and Instruction
Form 1 Donation Experience Survey	Form and Instruction
Form 1 National Marrow Donor Program Donation Experience Survey	Form and Instruction
Form A Instrument A MIECHV Site Visit Compliance Review Awardee Feedback Form	Form and Instruction
Form 1 Instrument A MIECHV Site Visit Compliance Review Awardee Feedback Form Boilerplate	Form and Instruction
Form 1 Maternal, Infant, and Early Childhood Home Visiting Site Visit Awardee Feedback Form	Form and Instruction
Form 1 On Site Compliance Review Awardee Feedback Form	Form
Form 1 Maternal, Infant, and Early Childhood Home Visiting Program On-Site Compliance Review Awardee Feedback Form	Form
Form 1 Conference Evaluation Survey	Form
Form 1 2024 Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Evaluation Surveys	Form
Form 3 Post Learning Collaborative Survey	Form and Instruction
Form 2 Instrument B_Post Webinar Survey	Form
Form 1 Annual Awardee Survey	Form
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form
Form 1 EHBs Customer Support Center Survey Screenshot	Form and Instruction
Form 1 Health Center Program Support Customer Service Survey	Form and Instruction
Form 1 EHB Customer Support Center Survey Screenshot	Form and Instruction
Form 1 HRSA Electronic Handbooks Customer Service Survey	Form and Instruction
Form Attachment D Attachment D_ECS TACC Semi-Annual Interview Protocol	Form and Instruction
Form C Attachment C_ECS TACC TA Resources Products Survey	Form and Instruction
Form B Attachment B_ECS TACC Webinar Survey	Form and Instruction
Form A Attachment A_ECS TACC Community of Practice Surve	Form and Instruction
Form A Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys	Form and Instruction
Form 1.2 FORM Reviewer Evaluation-Field Review Q 1 - 12	Form and Instruction
Form 1 FORM Reviewer Evaluation Q 1- 15	Form
Form 2 Form Chair Q 1-5	Form
Form 1.1 Screenshot Reviewer Instr	Form and Instruction
Form 1.1 Division of Independent Review Objective Review Assessment Survey	Form and Instruction
Form 1 DGMO Customer Service Survey Questions	Form
Form 1 Division of Grants Management Operations Customer Service Satisfaction Survey	Form
Focus Group Example_Screening Questions.docx	Supplementary Document
Focus Group Example_Informed Consent.docx	Supplementary Document
Focus Group Example_Focus Group Guide.docx	Supplementary Document
Supporting Statement B 12.8.23.docx	Supporting Statement B
Supporting Statement A 12.8.23.docx	Supporting Statement A
HRSA Web Survey	Form
HRSA Web Survey	Form
HRSA Web Survey	Form
Title V Information System User Satisfaction Survey	Form and Instruction
Title V Information System User Satisfaction Survey	Form and Instruction
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form
Tree Testing of HRSA's Ryan White HIV/AIDS Program website	Form
Tree Testing of HRSA's Ryan White HIV/AIDS Program website	Other-Tree Test Plan
Collection of Qualitative Feedback on Telehealth.HHS.gov	Form and Instruction
Collection of Qualitative Feedback on Telehealth.HHS.gov	Form and Instruction
Collection of Qualitative Feedback on Telehealth.HHS.gov	Form and Instruction
National Practitioner Data Bank Usability Survey	Form and Instruction
National Practitioner Data Bank Usability Survey	Form and Instruction
Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms	Form and Instruction
Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms	Form and Instruction
Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms	Form and Instruction
National Marrow Donor Program Donation Experience Survey	Form and Instruction
National Marrow Donor Program Donation Experience Survey	Form and Instruction
Maternal, Infant, and Early Childhood Home Visiting Site Visit Awardee Feedback Form	Form and Instruction
Maternal, Infant, and Early Childhood Home Visiting Site Visit Awardee Feedback Form	Form and Instruction
Maternal, Infant, and Early Childhood Home Visiting Site Visit Awardee Feedback Form	Form and Instruction
Maternal, Infant, and Early Childhood Home Visiting Program On-Site Compliance Review Awardee Feedback Form	Form
Maternal, Infant, and Early Childhood Home Visiting Program On-Site Compliance Review Awardee Feedback Form	Form
2024 Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Evaluation Surveys	Form
2024 Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Evaluation Surveys	Form
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form and Instruction
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Form
Health Center Program Support Customer Service Survey	Form and Instruction
Health Center Program Support Customer Service Survey	Form and Instruction
HRSA Electronic Handbooks Customer Service Survey	Form and Instruction
HRSA Electronic Handbooks Customer Service Survey	Form and Instruction
Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys	Form and Instruction
Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys	Form and Instruction
Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys	Form and Instruction
Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys	Form and Instruction
Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys	Form and Instruction
Division of Independent Review Objective Review Assessment Survey	Form and Instruction
Division of Independent Review Objective Review Assessment Survey	Form
Division of Independent Review Objective Review Assessment Survey	Form
Division of Independent Review Objective Review Assessment Survey	Form and Instruction
Division of Independent Review Objective Review Assessment Survey	Form and Instruction
Division of Independent Review Objective Review Assessment Survey	Other-Public Burden Statement Screenshot
Division of Grants Management Operations Customer Service Satisfaction Survey	Form
Division of Grants Management Operations Customer Service Satisfaction Survey	Form

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Action
202401-0915-004	Revision of a currently approved collection	2024-01-10	Approved without change
202401-0915-001	No material or nonsubstantive change to a currently approved collection	2024-01-04	Approved without change
202312-0915-001	No material or nonsubstantive change to a currently approved collection	2023-12-14	Approved without change
202308-0915-005	No material or nonsubstantive change to a currently approved collection	2023-08-17	Approved without change
202103-0915-002	Extension without change of a currently approved collection	2021-03-16	Approved without change
202012-0915-001	No material or nonsubstantive change to a currently approved collection	2020-12-08	Approved without change
201506-0915-001	Extension without change of a currently approved collection	2018-05-15	Approved with change
201502-0915-002	Extension without change of a currently approved collection	2015-03-12	Approved without change
201206-0915-002	Revision of a currently approved collection	2012-06-08	Approved with change
200904-0915-002	Extension without change of a currently approved collection	2009-04-27	Approved without change
200809-0915-001	No material or nonsubstantive change to a currently approved collection	2008-09-03	Approved without change
200709-0915-002	No material or nonsubstantive change to a currently approved collection	2007-09-23	Withdrawn and continue
200707-0915-004	No material or nonsubstantive change to a currently approved collection	2007-07-30	Withdrawn and continue
200603-0915-001	Extension without change of a currently approved collection	2006-03-20	Approved without change
200302-0915-001	Extension without change of a currently approved collection	2003-02-05	Approved without change
200002-0915-004	Extension without change of a currently approved collection	2000-02-24	Approved without change
199702-0915-001	New collection (Request for a new OMB Control Number)	1997-02-03	Approved without change

OMB Details

Building Futures: Supporting Youth Living with HIV, Feedback on Toolkit and Webinars

Federal Enterprise Architecture: Health - Health Care Services

Information collection instruments
Form	Name	Electronic access	Type
Form 1	BF_Webinar_Survey_4_24_2018.docx	Fillable Fileable	Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.