Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
MCH Nutrition Training Needs Assessment Unchanged 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 Unchanged 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
2024 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program All Grantee Meeting Evaluation Surveys Unchanged 1960 102 0 Form 1 Conference Evaluation Survey
Form 2 Plenary Session Evaluation Survey
Form 3 Concurrent Session Evaluation Survey
Form 4 AGM Poster Session Evaluation Survey
Be The Match Donation Experience Survey Unchanged 1625 218 0 Form and Instruction 1 BTM Donation Experience Survey - CLEAN.docx
Collection of Qualitative Feedback on Telehealth.HHS.gov Unchanged 17465 99 0 Form 1 Telehealth Website - Page Level - SurveyEngSpan.docx
Form 2 Telehealth Website - Site Level - Survey EngSpan.docx
Customer Feedback Survey Unchanged 1844 154 0 Form and Instruction 1 Customer Feedback Survey
DGMO Customer Service Satisfaction Survey Unchanged 768 92 0 Form 1 DGMO Customer Service Survey Questions.docx
DIR Objective Review Assessment Survey Unchanged 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 Unchanged 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
Evaluation Survey of Eligible National Practitioner Data Bank (NPDB) Entity Users: Relevance of Information Collected via NPDB Query Forms Modified 900 150 0 Form and Instruction 1 User Survey Questions-Query FINAL For Clearance
Federal Cervical Cancer Collaborative (FCCC) Post-Roundtable Evaluation Unchanged 200 17 0 Form and Instruction 1 Post-Roundtable-Survey_V02-Final.pdf
Feedback and Lessons Learned from CBO Program Award Recipients Unchanged 100 133 0 Instruction
Instruction
Instruction
HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach (Online Focus Groups) Unchanged 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 Unchanged 5000 40 0 Form and Instruction 1 EHBs Customer Support Center Survey Screenshot.docx
HRSA Web Survey Unchanged 16667 833 0 Form 1 English Version_HRSA Web Survey
Form 2 Spanish Version_HRSA Web Survey
Health Center COVID-19 Vaccine Program (HCVP) After-Action Survey Unchanged 1505 376 0 Instruction
Health Center Program Support (HCPS) Customer Service Survey Unchanged 800 40 0 Form 1 HCPS - 2021 Sample Customer Service Survey--Salesforce In Sandbox.docx
Listening Session Questions Unchanged 90 90 0 Form and Instruction 1 Listening Session Questions
MIECHV Site Visit Awardee Feedback Form New 270 68 0 Form and Instruction 1 A
Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program On-Site Compliance Review Awardee Feedback Form Unchanged 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 Unchanged 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 Unchanged 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
National Organ Donation Expert Opinion Survey Unchanged 18 6 0 Instruction
National Practitioner Data Bank (NPDB) Usability Survey Unchanged 200 200 0 Form and Instruction 1 National Practitioner Data Bank (NPDB) Usability Survey
Organdonor.gov Website Survey Unchanged 400 67 0 Form and Instruction 1 HRSA DoT Organdonor.gov Website Survey Questionnaire.docx
Primary Health Care Digest Newsletter Subscriber Survey Unchanged 5000 583 0 Form and Instruction 1 Primary Health Care Digest Newsletter Subscriber Survey
Title V Information System (TVIS) User Satisfaction Survey Unchanged 70 12 0 Form and Instruction 1 Screen Shots of Title V Information System Survey 2021
Trainee Ambassador Group Survey Unchanged 90 23 0 Form and Instruction 1 Trainee Ambassador Group Survey
Tree Testing of HRSA's Ryan White HIV/AIDS Program website Unchanged 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: 62215 4781 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
To view an IC, click on IC Title