Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
(MIECHV MODS) Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) Developing Strategies to Facilitate Cross-Model Collaboration and Data Sharing – Customer Satisfaction Survey Forms New 216 17 0 Form A
Form B
Form C
2018 National Ryan White Conference on HIV Care & Treatment Evaluation New 18761 526 0 Form and Instruction 1
Form and Instruction 2
Form and Instruction 3
Form and Instruction 4
2020 National Ryan White Conference on HIV Care and Treatment New 21193 566 0 Form and Instruction 1
Form and Instruction 2
Form and Instruction 3
Form and Instruction 4
Building Futures: Supporting Youth Living with HIV, Feedback on Toolkit and Webinars New 300 25 0 Form 1
Collection of Qualitative Feedback on Telehealth.HHS.gov New 200000 1389 0 Form 1
Form 2
DGMO Customer Service Satisfaction Survey New 768 92 0 Form 1
DIR Objective Peer Review Assessment Survey New 2300 575 0 Form and Instruction 1
Instruction
Form 1Q1
Form 1Q2
Form 1Q3
Form 1Q4
Form 1Q5
Instruction
Form 2Q1
Form 2Q2
Division of Practitioner Data Bank (DPDB) Feedback and Satisfaction Surveys New 600 100 0 Form 1
Donation Experience Survey New 1625 218 0 Form and Instruction 1
Form and Instruction 1 R
HRSA Division of Practitioner Data Bank (DPDB) 2019 Education Forum Participant Survey New 150 3 0 Form and Instruction 1
HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach New 896 301 0 Form and Instruction 1
Other-Screener
Form and Instruction 2
Health Center Program Support Customer Service Survey New 201 10 0 Form 1
Maternal and Child Health Epidemiology Training Course One-Year Follow-up Survey New 40 10 0 Form 1
Maternal and Child Health Nutrition Training Needs Assessment New 65 16 0 Form and Instruction 1
Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) On-Site Compliance Review Awardee Feedback Form New 165 41 0 Form 1
Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) On-Site Compliance Review Awardee Feedback Form New 165 41 0 Form A
Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Feedback Forms New 1390 51 0 Form A
Form B
Maternal, Infant, and Early Childhood Home Visiting Program HV-ImpACT Technical Assistance Program Feedback and Satisfaction Surveys New 3100 256 0 Form A
Form B
Form C
Form D
Form E
Maternal, Infant, and Early Childhood Home Visiting Program HV-PM/CQI Technical Assistance Center Satisfaction Surveys New 1150 112 0 Form A
Form B
Form C
Form D
National Practitioner Data Bank (NPDB) Usability Surveys New 200 200 0 Form and Instruction 1
National Practitioner Data Bank Call Center Customer Satisfaction Survey New 1440 360 0 Form 1
OAMP Customer Satisfaction Survey New 985 246 0 Form 1
Title V Information System (TVIS) User Satisfaction Survey New 76 13 0 Form and Instruction 1
UDS Reporting Modernization Customer Satisfaction Survey New 1469 122 0 Form and Instruction 1
Virtual Interviews with Members of the Public to Assess Customer Experience with Organ Donation PSAs New 32 16 0 Form and Instruction 1
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 257287 5306 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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