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 Attachment A - Data Science Training Survey.docx
Form B Attachment B - Resource Guide Survey.docx
Form C Attachment C - List of Analytic Experts Survey.docx
2018 National Ryan White Conference on HIV Care & Treatment Evaluation New 18761 526 0 Form and Instruction 1 Ryan White 2018 Session Evaluation 9.18.2018 FINAL2.pdf
Form and Instruction 2 Breakout Session Evaluation Questions_final.docx
Form and Instruction 3 Plenary Session Evaluation Questions_final.docx
Form and Instruction 4 Overall 2018 NRWC Evaluation_final.docx
2020 National Ryan White Conference on HIV Care and Treatment New 21193 566 0 Form and Instruction 1 Overall 2020 NRWC Conference Evaluation.docx
Form and Instruction 2 2020 NWRC Breakout Evaluation Questions for App.docx
Form and Instruction 3 2020 NWRC Plenary Evaluation Questions for App.docx
Form and Instruction 4 2020 Ryan White CEU Session Evaluation Form.docx
Building Futures: Supporting Youth Living with HIV, Feedback on Toolkit and Webinars New 300 25 0 Form 1 BF_Webinar_Survey_4_24_2018.docx
Collection of Qualitative Feedback on Telehealth.HHS.gov New 200000 1389 0 Form 1 Telehealth Website - Page Level - SurveyEngSpan.docx
Form 2 Telehealth Website - Site Level - Survey EngSpan.docx
DGMO Customer Service Satisfaction Survey New 768 92 0 Form 1 DGMO Customer Service Survey Questions.docx
DIR Objective Peer Review Assessment Survey New 2300 575 0 Form and Instruction 1 0212 DIR OMB Survey Binder 8-1-18.pdf - SHOWS BURDEN STMNT, OMB NO AND EXP DATE
Instruction
Form 1Q1 DIR Review Assessment Survey form 1 - screenshot Reviwer Q1.png
Form 1Q2 DIR Review Assessment Survey form 1 - screenshot ReviewerQ2.png
Form 1Q3 DIR Review Assessment Survey form 1 - screenshot Reviwer3.png
Form 1Q4 DIR Review Assessment Survey form 1 - screenshot ReviwerQ4.png
Form 1Q5 DIR Review Assessment Survey form 1 - screenshot ReviwerQ5.png
Instruction
Form 2Q1 DIR Review Assessment Survey form 2 - screenshot ChairQ 1.png
Form 2Q2 DIR Review Assessment Survey form 2 - screenshot Chair ReviewQ2.png
Division of Practitioner Data Bank (DPDB) Feedback and Satisfaction Surveys New 600 100 0 Form 1 National Practitioner Data Bank (NPDB) Webcast Survey
Donation Experience Survey New 1625 218 0 Form and Instruction 1 New Survey - Be The Match Donation Experience Generic.docx
Form and Instruction 1 R Old Survey Redline - Be The Match Donation Experience Generic.docx
HRSA Division of Practitioner Data Bank (DPDB) 2019 Education Forum Participant Survey New 150 3 0 Form and Instruction 1 2019 NPDB Education Forum Feedback Survey.pdf
HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach New 896 301 0 Form and Instruction 1 FORM Focus Group CLEAN.docx
Other-Screener
Form and Instruction 2 FORM Survey Questions CLEAN.docx
Health Center Program Support Customer Service Survey New 201 10 0 Form 1 Sample Customer Service Survey--Salesforce In Test.docx
Maternal and Child Health Epidemiology Training Course One-Year Follow-up Survey New 40 10 0 Form 1 One-Year Trainee Survey form.docx
Maternal and Child Health Nutrition Training Needs Assessment New 65 16 0 Form and Instruction 1 Survey MCH Nutrition Training Needs Assessment.docx
Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) On-Site Compliance Review Awardee Feedback Form New 165 41 0 Form 1 MIECHV On-Site Compliance Review Awardee Feedback Form.docx
Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) On-Site Compliance Review Awardee Feedback Form New 165 41 0 Form A Attachment A-MIECHV On-Site Compliance Review Awardee Feedback Form.docx
Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Feedback Forms New 1390 51 0 Form A All Grantee Meeting Feedback
Form B All Grantee Meeting Individual Session Feeback
Maternal, Infant, and Early Childhood Home Visiting Program HV-ImpACT Technical Assistance Program Feedback and Satisfaction Surveys New 3100 256 0 Form A Attachment A-Annual Satisfaction Survey.docx
Form B Attachment B-HV-ImpACT Event Survey.docx
Form C Attachment C-Community of Practice Survey.docx
Form D Attachment D-Targeted TA Project Officer survey.docx
Form E Attachment E-Newsletter Survey.docx
Maternal, Infant, and Early Childhood Home Visiting Program HV-PM/CQI Technical Assistance Center Satisfaction Surveys New 1150 112 0 Form A Attachment A - HV-PMCQI Annual Survey.docx
Form B Attachment B - HV-PMCQI Information Request Survey.docx
Form C Attachment C - HV-PMCQI Individualized TA Survey.docx
Form D Attachment D - HV-PMCQI Webinar Survey.docx
National Practitioner Data Bank (NPDB) Usability Surveys New 200 200 0 Form and Instruction 1 National Practitioner Data Bank (NPDB) Usability Surveys
National Practitioner Data Bank Call Center Customer Satisfaction Survey New 1440 360 0 Form 1 NPDB Customer Survey Questions.docx
OAMP Customer Satisfaction Survey New 985 246 0 Form 1 Example Survey in Survey Monkey - OAMP.pdf
Title V Information System (TVIS) User Satisfaction Survey New 76 13 0 Form and Instruction 1 Screen Shots of Title V Information System Survey 2018.docx
UDS Reporting Modernization Customer Satisfaction Survey New 1469 122 0 Form and Instruction 1 UDS Reporting Modernization Customer Satisfaction Survey
Virtual Interviews with Members of the Public to Assess Customer Experience with Organ Donation PSAs New 32 16 0 Form and Instruction 1 Interview Guide - OMB Outreach Evaluations CLEAN.RA.docx
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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