Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
BPHC Customer Service Survey New 1900 95 0 Form and Instruction 1 Customer Feedback Survey
MIECHV TARC Satisfaction Survey New 967 145 0 Form and Instruction 1 Adaptive Leadership Academy Completion Survey
Form and Instruction 2 Community of Practice Survey Completion Survey
Form and Instruction 3 Practicum Check In Survey
Form and Instruction 4 CQI Practicum Polls
Form and Instruction 5 Individualized Targeted TA Check in
Form and Instruction 6 Small Group TA Closeout Survey
Form and Instruction 7 TARC Meeting Poll
Form and Instruction 9 Webinar Survey
Form and Instruction 8 CQI Practicum Completion Survey
Form and Instruction 10 Individualized Targeted TA
2024 Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Evaluation Surveys New 1960 102 0 Form 1 Conference Evaluation Survey
2024 National Ryan White Conference on HIV Care & Treatment Evaluation New 937 325 0 Form 2 2024 NWRC Conference Session Questionaire
Form 3 2024 Ryan White CEU Session Evaluation
Form and Instruction 1 Overall 2024 NRWC Conference Evaluation
Collection of Qualitative Feedback on Telehealth.HHS.gov New 17465 99 0 Form and Instruction 1 Telehealth Website - Page Level - SurveyEngSpan
Form and Instruction 2 Telehealth Website - Site Level - Survey EngSpan
Collection of Qualitative Feedback on Telehealth.HHS.gov New 6600 48 0 Form 1 Website user (page-level survey)
Form 2 Website user (site-wide survey)
DIR Objective Review Assessment Survey New 900 450 0 Instruction
Form and Instruction 1 Questions 1-5
Form and Instruction 2 Reviewer Evaluation Form
Form and Instruction 3 Reviewer Evaluation Field Review
Form and Instruction 1A Chair Reviewer Evaluation Q1-2
Form and Instruction 1B Chair Reviewer Evaluation Review Form Q3-4
Form and Instruction 1C Chair Reviewer Evaluation Review Q5
Form and Instruction 2A Reviewer Evaluation- Field Review Q1-2
Form and Instruction 2B Reviewer Evaluation- Field Review Q3-4
Form and Instruction 2C Reviewer Evaluation- Field Review Q5-6
Form and Instruction 2D Reviewer Evaluation- Field Review Q7-8
Form and Instruction 2E Reviewer Evaluation- Field Review Q9-10
Form and Instruction 2F Reviewer Evaluation- Field Review Q11-12
Form and Instruction 3A Reviewer Evaluation Q1-2
Form and Instruction 3B Reviewer Evaluation- Field Review Q3-4
Form and Instruction 3C Reviewer Evaluation- Field Review Q5-6
Form and Instruction 3E Reviewer Evaluation Q9-10
Form and Instruction 3D Reviewer Evaluation- Field Review Q7-8
Form and Instruction 3F Reviewer Evaluation- Field Review Q11-12
Form and Instruction 3G Reviewer Evaluation- Field Review Q13-14
Form and Instruction 3H Reviewer Evaluation- Field Review Q15
Division of Grants Management Operations Customer Service Satisfaction Survey New 768 92 0 Form 1 DGMO Customer Service Survey Questions
Division of Independent Review Objective Review Assessment Survey New 2300 575 0 Form and Instruction 1.1 Screenshot Reviewer Instr
Form 2 Form Chair Q 1-5
Form 1 FORM Reviewer Evaluation Q 1- 15
Form and Instruction 1.2 FORM Reviewer Evaluation-Field Review Q 1 - 12
Other-Public Burden Statement Screenshot
Division of Practitioner Data Bank (DPDB) Webinar Feedback and Satisfaction Surveys New 2400 200 0 Form 1 Webinar Survey Questions
Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys New 320 79 0 Form and Instruction A Attachment A_ECS TACC Community of Practice Surve
Form and Instruction B Attachment B_ECS TACC Webinar Survey
Form and Instruction C Attachment C_ECS TACC TA Resources Products Survey
Form and Instruction Attachment D Attachment D_ECS TACC Semi-Annual Interview Protocol
Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms New 900 150 0 Form and Instruction 1 Query Survey Intro-Instructions
Form and Instruction 2 User Survey Questions - Query
Federal Cervical Cancer Collaborative (FCCC) CERV-Net Evaluation New 48 36 0 Form and Instruction 1 CERV-Net 3-Month Follow-Up Test
Form and Instruction 2 CERV-Net Post-Test
Form and Instruction 3 CERV-Net Pre-Test
HRSA Electronic Handbooks Customer Service Survey New 5000 40 0 Form and Instruction 1 EHB Customer Support Center Survey Screenshot
HRSA Web Survey New 16667 833 0 Form 1 HRSA Web Survey
Form 2 HRSA Web Survey (Spanish Language)
HRSA Web Survey New 16667 833 0 Form 1 English Language Survey
Form 2 Spanish Language Survey
HRSA/HIV & AIDS Bureau (HAB) Recipients Satisfaction Survey (RSS). New 250 58 0 Form and Instruction 1 HAB Recipients Satisfaction Survey
Health Center Program Support Customer Service Survey New 800 40 0 Form and Instruction 1 EHBs Customer Support Center Survey Screenshot
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys New 665 70 0 Form 1 Annual Awardee Survey
Form 2 Instrument B_Post Webinar Survey
Form and Instruction 3 Post Learning Collaborative Survey
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center 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 CQI Practicum Completion Survey
Maternal, Infant, and Early Childhood Home Visiting Program On-Site Compliance Review Awardee Feedback Form New 315 79 0 Form 1 On Site Compliance Review Awardee Feedback Form
Maternal, Infant, and Early Childhood Home Visiting Site Visit Awardee Feedback Form New 270 68 0 Form and Instruction 1 Instrument A MIECHV Site Visit Compliance Review Awardee Feedback Form Boilerplate
Form and Instruction A Instrument A MIECHV Site Visit Compliance Review Awardee Feedback Form
National Marrow Donor Program Donation Experience Survey New 1672 217 0 Form and Instruction 1 Donation Experience Survey
National Practitioner Data Bank Usability Survey New 200 200 0 Form and Instruction 1 0915-0212_UsabiltyTesting Instrument_NPDBSystem
Technical Assistance to Support the HHS Viral Hepatitis National Strategic Plan New 25 25 0 Other-Interview Questions
Title V Information System 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 Other-Tree Test Plan
Form 1 Tree Test Script
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 82346 5105 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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