OMB control number

Questionnaire and Data Collection Testing, Evaluation, and Research for the Health Resources and Services Administration (HRSA)

OMB 0915-0379 · HHS/HSA.

OMB 0915-0379

The overarching generic clearance for Questionnaire and Data Collection Testing, Evaluation, and Research provides HRSA with the opportunity to collect feedback from members of the public for HRSA to use when developing new questions, questionnaires, and tools; pilot/pre-test instruments to be deployed by HRSA; and to identify problems in instruments currently in use. HRSA seeks to extend OMB approval of this ICR and existing ICRs that fall under it while including a slight increase in the burden estimate to account for HRSA’s implementation of Executive Order 13985, which calls on agencies to advance racial equity and support for underserved communities through identifying and addressing barriers to equal opportunity that underserved communities may face. HRSA will likely conduct additional collections to gather information from the public so that HRSA may effectively implement this Executive Order. This generic clearance is limited to data collection for the development or revision of HRSA tools and data collection instruments, as well as reports for internal decision-making and development purposes. Information collected under this generic clearance will not be used for data collection, reports, or policy documents to be released to the public. It is anticipated that data collection approved under this generic clearance will rely heavily on qualitative techniques and not the collection of numerical data. In general, these activities are not designed to yield results that meet generally accepted standards of statistical rigor but designed to obtain information to develop clearer and more effective and efficient data collection tools that will yield more accurate results and decrease public non-response. The forms submitted under this generic clearance will be voluntary, low-burden, and uncontroversial. In addition, HRSA requests to renew the following currently approved instruments under 0915-0379 along with the renewal of this generic umbrella collection: • Health Center Workforce Well-Being Survey: Listening Sessions • Health Center Workforce Well-Being Survey: Cognitive Sessions • Health Center Workforce Well-Being Survey: Pilot Testing • Health Center Workforce Survey Evaluation and Technical Assistance: Pilot Survey • Fast Track Interviews with National Hypertension Control Initiative (NHCI) Group 2 Participants. • Usability Testing for HRSA.gov website properties (moving from 0990-0379) • Organ Procurement and Transplantation Network (OPTN) Stakeholder Focus Groups • Ryan White HIV/AIDS Program Tree Testing Plan • PRA Questions for CEN Groups

The latest form for Questionnaire and Data Collection Testing, Evaluation, and Research for the Health Resources and Services Administration (HRSA) expires 2026-11-30 and is listed under ICR 202306-0915-006.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 1 Facilitator Guide - New Applicant Toolkit (Part 2) (document unavailable)Form and Instruction
Form 1 Final Report Stakeholder Contact Language (document unavailable)Form and Instruction
Form 4 Student Training Feedback Form (document unavailable)Form and Instruction
Form 3 Operations Partner Feedback Form (document unavailable)Form and Instruction
Form 2 Faculty Training Feedback Form (document unavailable)Form and Instruction
Form 1 Collaborators Feedback Form (document unavailable)Form and Instruction
Form 1 CEN Financial Facilitator Guide (document unavailable)Form and Instruction
Form 1 Opening Questions (document unavailable)Form and Instruction
Form 3 Medical Malpractice Payment Reports Module (document unavailable)Form and Instruction
Form 4 Judgment or Conviction Reports Module (document unavailable)Form and Instruction
Form 5 Closing Questions (document unavailable)Form and Instruction
Form 2 Adverse Action Reports Module (document unavailable)Form and Instruction
Form 1 Informed ConsentForm
Form 2 HRSA Survey DraftForm and Instruction
Form 2 HRSA Health Center Workforce Survey: Pilot SurveyForm and Instruction
Form 1 SurveyForm
Form 1 ealth Center Workforce Survey Evaluation and Technical Assistance: Pilot SurveyForm
Form 1 Cognitive Interview Informed ConsentForm
Form 1 HRSA Health Center Workforce Survey: Cognitive InterviewsForm
Form 1 Listening Session Consent FormForm
Supporting Statement A Revision_clean.docxSupporting Statement A
Supporting Statement B Revision_clean.docxSupporting Statement B
Health Center Community Engagement Network (CEN) – New Applicant Toolkit Project- Group 2 Form and Instruction
Primary Care and Behavioral Health Integration (PCBHI) Training Follow Up Discussion Instruction
National Organ Donation Expert Opinion Survey for Information Dissemination Form and Instruction
Health Center Community Engagement Network (CEN) – New Applicant Toolkit Project Instruction
Morgan State University Maternal Health Equity Coordinating Center (MSU MHECC) Feedback Forms Form and Instruction
Morgan State University Maternal Health Equity Coordinating Center (MSU MHECC) Feedback Forms Form and Instruction
Morgan State University Maternal Health Equity Coordinating Center (MSU MHECC) Feedback Forms Form and Instruction
Morgan State University Maternal Health Equity Coordinating Center (MSU MHECC) Feedback Forms Form and Instruction
Health Center Community Engagement Network (CEN)- Financial Sustainability AG Form and Instruction
Evaluation Survey of Eligible National Practitioner Data Bank (NPDB) Entity Users: Relevance of Information Collected via NPDB Report Forms Form and Instruction
Evaluation Survey of Eligible National Practitioner Data Bank (NPDB) Entity Users: Relevance of Information Collected via NPDB Report Forms Form and Instruction
Evaluation Survey of Eligible National Practitioner Data Bank (NPDB) Entity Users: Relevance of Information Collected via NPDB Report Forms Form and Instruction
Evaluation Survey of Eligible National Practitioner Data Bank (NPDB) Entity Users: Relevance of Information Collected via NPDB Report Forms Form and Instruction
Evaluation Survey of Eligible National Practitioner Data Bank (NPDB) Entity Users: Relevance of Information Collected via NPDB Report Forms Form and Instruction
Evaluation Survey of Eligible National Practitioner Data Bank (NPDB) Entity Users: Relevance of Information Collected via NPDB Report Forms Instruction
PRA Questions for CEN Groups Instruction
Organ Procurement and Transplantation Network (OPTN) Stakeholder Focus Groups Instruction
HRSA Health Center Workforce Survey: Pilot Survey Form
HRSA Health Center Workforce Survey: Pilot Survey Form and Instruction
HRSA Health Center Workforce Survey: Pilot Survey Form and Instruction
ealth Center Workforce Survey Evaluation and Technical Assistance: Pilot Survey Form
ealth Center Workforce Survey Evaluation and Technical Assistance: Pilot Survey Form
HRSA Health Center Workforce Survey: Cognitive Interviews Form
HRSA Health Center Workforce Survey: Cognitive Interviews Form
Health Center Workforce Survey: Listening Sessions Form
Health Center Workforce Survey: Listening Sessions Other-Slide Deck
Usability Testing for HRSA.gov website properties Instruction
Interviews with National Hypertension Control Initiative (NHCI) Group 2 Participants Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202306-0915-006 Revision of a currently approved collection 2023-06-29 Approved without change
202004-0915-007 Extension without change of a currently approved collection 2020-05-15 Approved with change
201704-0915-001 Extension without change of a currently approved collection 2017-04-26 Approved with change
201402-0915-003 New collection (Request for a new OMB Control Number) 2014-02-14 Approved with change

OMB Details

Interviews with National Hypertension Control Initiative (NHCI) Group 2 Participants

Federal Enterprise Architecture: Health - Health Care Services