Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
MCH Nutrition Training Needs Assessment New 59 15 0 Form and Instruction 1 Survey 2022 MCH Nutrition Training Needs Assessment_10.29.21.docx
2022 National Ryan White Conference on HIV Care & Treatment Evaluation New 1250 331 0 Form and Instruction 1 Conference Plenary Session Evaluation
Form and Instruction 2 Conference Breakout Session Evaluation
Form and Instruction 3 CEU Breakout Session Evaluation
Form and Instruction 4 Conference (Overall) Evaluation
Be The Match Donation Experience Survey New 1625 218 0 Form and Instruction 1 BTM Donation Experience Survey - CLEAN.docx
Collection of Qualitative Feedback on Telehealth.HHS.gov New 17465 99 0 Form 1 Telehealth Website - Page Level - SurveyEngSpan.docx
Form 2 Telehealth Website - Site Level - Survey EngSpan.docx
Customer Feedback Survey New 1844 154 0 Form and Instruction 1 Customer Feedback Survey
DGMO Customer Service Satisfaction Survey New 768 92 0 Form 1 DGMO Customer Service Survey Questions.docx
DIR Objective Review Assessment Survey New 2300 575 0 Instruction
Form 1 Reviewer Evaluation Q 1- 15.pdf
Form 1.2 Reviewer Evaluation-Field Review Q 1 - 12.pdf
Form and Instruction 2 FORM CHAIR Q 1-5.pdf
Other-Public Burden Screenshot
Early Childhood Systems Technical Assistance and Coordinating Center (ECS TACC) Customer Satisfaction Surveys New 320 79 0 Form A Attachment A_ECS TACC Community of Practice Survey.docx
Form B Attachment B_ECS TACC Webinar Survey.docx
Form C Attachment C_ECS TACC TA Resources Products Survey.docx
Form D Attachment D_ECS TACC Semi-Annual Interview Protocol.docx
Federal Cervical Cancer Collaborative (FCCC) Post-Roundtable Evaluation New 200 17 0 Form and Instruction 1 Post-Roundtable-Survey_V02-Final.pdf
Feedback and Lessons Learned from CBO Program Award Recipients New 100 133 0 Instruction
Instruction
Instruction
HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach (Online Focus Groups) New 54 95 0 Form and Instruction 1 Focus Group Moderators Guide
Form and Instruction 3 Informed Consent
Form and Instruction 2 Screening Questions
HRSA Electronic Handbooks Customer Service Survey New 5000 40 0 Form and Instruction 1 EHBs Customer Support Center Survey Screenshot.docx
Health Center COVID-19 Vaccine Program (HCVP) After-Action Survey New 1505 376 0 Instruction
Health Center Program Support (HCPS) Customer Service Survey New 800 40 0 Form 1 HCPS - 2021 Sample Customer Service Survey--Salesforce In Sandbox.docx
Listening Session Questions New 90 90 0 Form and Instruction 1 Listening Session Questions
Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program On-Site Compliance Review Awardee Feedback Form New 315 79 0 Form 1 MIECHV On-Site Compliance Review Awardee Feedback Form_May2021.docx
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center (ITAC) Satisfaction Surveys New 665 70 0 Form 1 Annual Awardee Survey
Form 2 Post Webinar Survey
Form 3 Post Learning Collaborative Survey
Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys New 2230 209 0 Form 1 Attachment A_Individualized Targeted TA Check in
Form 2 Attachment B_Individualized Targeted TA Closeout
Form 3 Attachment C_Project Officer Survey
Form 4 Attachment D_Webinar Survey
Form 5 Attachment E_Community of Practice Survey
Form 6 Attachment F_Leadership Academy Session Survey
Form 7 Attachment G_Leadership Academy Completion Survey
Form 8 Attachment H_Quarterly Overall TA Survey
Form 9 Attachment I_CQI Practicum Check in Survey
Form 10 Attachment J_CQI Practicum Completion Survey
Organdonor.gov Website Survey New 400 67 0 Form and Instruction 1 HRSA DoT Organdonor.gov Website Survey Questionnaire.docx
Primary Health Care Digest Newsletter Subscriber Survey New 5000 583 0 Form and Instruction 1 Primary Health Care Digest Newsletter Subscriber Survey
Title V Information System (TVIS) User Satisfaction Survey New 70 12 0 Form and Instruction 1 Screen Shots of Title V Information System Survey 2021
Tree Testing of HRSA's Ryan White HIV/AIDS Program website New 50 25 0 Form and Instruction 1 Tree Test Plan
Form and Instruction 1 Tree Test Script
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 42110 3399 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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