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 Unchanged 216 17 0 Form A
Form B
Form C
2018 National Ryan White Conference on HIV Care & Treatment Evaluation Unchanged 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 Unchanged 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 Unchanged 300 25 0 Form 1
Collection of Qualitative Feedback on Telehealth.HHS.gov Unchanged 200000 1389 0 Form 1
Form 2
Constituent Feedback to Oral Health Education Messages and Materials New 308 182 0 Form 1-1 RS
Form 1-2 RS
Form 1-3 RS
Form 2-1 EP
Form 2-2 EP
Form 2-3 EP
DGMO Customer Service Satisfaction Survey Unchanged 768 92 0 Form 1
DIR Objective Peer Review Assessment Survey Unchanged 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 Unchanged 600 100 0 Form 1
Donation Experience Survey Unchanged 1625 218 0 Form and Instruction 1
Form and Instruction 1 R
HRSA Division of Practitioner Data Bank (DPDB) 2019 Education Forum Participant Survey Unchanged 150 3 0 Form and Instruction 1
HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach Unchanged 896 301 0 Form and Instruction 1
Other-Screener
Form and Instruction 2
Health Center Program Support Customer Service Survey Unchanged 201 10 0 Form 1
Maternal and Child Health Epidemiology Training Course One-Year Follow-up Survey Unchanged 40 10 0 Form 1
Maternal and Child Health Nutrition Training Needs Assessment Unchanged 65 16 0 Form and Instruction 1
Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) On-Site Compliance Review Awardee Feedback Form Unchanged 165 41 0 Form 1
Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) On-Site Compliance Review Awardee Feedback Form Unchanged 165 41 0 Form A
Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Feedback Forms Unchanged 1390 51 0 Form A
Form B
Maternal, Infant, and Early Childhood Home Visiting Program HV-ImpACT Technical Assistance Program Feedback and Satisfaction Surveys Unchanged 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 Unchanged 1150 112 0 Form A
Form B
Form C
Form D
National Practitioner Data Bank (NPDB) Usability Surveys Unchanged 200 200 0 Form and Instruction 1
National Practitioner Data Bank Call Center Customer Satisfaction Survey Unchanged 1440 360 0 Form 1
OAMP Customer Satisfaction Survey Unchanged 985 246 0 Form 1
Title V Information System (TVIS) User Satisfaction Survey Unchanged 76 13 0 Form and Instruction 1
UDS Reporting Modernization Customer Satisfaction Survey Unchanged 1469 122 0 Form and Instruction 1
Virtual Interviews with Members of the Public to Assess Customer Experience with Organ Donation PSAs Unchanged 32 16 0 Form and Instruction 1
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 257595 5488 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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