Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
BPHC Customer Service Survey Modified 1900 95 0 Form and Instruction 1
MIECHV TARC Satisfaction Survey Modified 967 145 0 Form and Instruction 1
Form and Instruction 2
Form and Instruction 3
Form and Instruction 4
Form and Instruction 5
Form and Instruction 6
Form and Instruction 7
Form and Instruction 9
Form and Instruction 8
Form and Instruction 10
2024 Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Evaluation Surveys Modified 1960 102 0 Form 1
2024 National Ryan White Conference on HIV Care & Treatment Evaluation Modified 937 325 0 Form 2
Form 3
Form and Instruction 1
Collection of Qualitative Feedback on Telehealth.HHS.gov Modified 6600 48 0 Form 1
Form 2
Collection of Qualitative Feedback on Telehealth.HHS.gov Modified 17465 99 0 Form and Instruction 1
Form and Instruction 2
DIR Objective Review Assessment Survey Modified 900 450 0 Instruction
Form and Instruction 1
Form and Instruction 2
Form and Instruction 3
Form and Instruction 1A
Form and Instruction 1B
Form and Instruction 1C
Form and Instruction 2A
Form and Instruction 2B
Form and Instruction 2C
Form and Instruction 2D
Form and Instruction 2E
Form and Instruction 2F
Form and Instruction 3A
Form and Instruction 3B
Form and Instruction 3C
Form and Instruction 3E
Form and Instruction 3D
Form and Instruction 3F
Form and Instruction 3G
Form and Instruction 3H
Division of Grants Management Operations Customer Service Satisfaction Survey Modified 768 92 0 Form 1
Division of Independent Review Objective Review Assessment Survey Modified 2300 575 0 Form and Instruction 1.1
Form 2
Form 1
Form and Instruction 1.2
Other-Public Burden Statement Screenshot
Division of Practitioner Data Bank (DPDB) Webinar Feedback and Satisfaction Surveys Modified 2400 200 0 Form 1
Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys Modified 320 79 0 Form and Instruction A
Form and Instruction B
Form and Instruction C
Form and Instruction Attachment D
Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms Modified 900 150 0 Form and Instruction 1
Form and Instruction 2
Expanding Health Center Awareness of Sexual Assault-Related Health Care Needs (SATA) Evaluation Modified 582 104 0 Form and Instruction 1
Form and Instruction 2
Form and Instruction 3
FTCA Office Hours Participant Feedback Survey Modified 1473 74 0 Form 1
FTCA Site Visit Follow-Up Survey New 5960 298 0 Form 1
Federal Cervical Cancer Collaborative (FCCC) CERV-Net Evaluation Modified 48 36 0 Form and Instruction 1
Form and Instruction 2
Form and Instruction 3
Follow up: ASPR/ Strategic National Stockpile (SNS) Dissemination and HRSA-Supported Health Centers use of JYNNEOS vaccine. Modified 100 8 0 Form 1
HRSA Electronic Handbooks Customer Service Survey Modified 5000 40 0 Form and Instruction 1
HRSA OPTN Patient Service Line Customer Satisfaction Survey Modified 500 25 0 Form 1
HRSA Web Survey Modified 16667 833 0 Form 1
Form 2
HRSA Web Survey Modified 16667 833 0 Form 1
Form 2
HRSA/HIV & AIDS Bureau (HAB) Recipients Satisfaction Survey (RSS). Modified 250 58 0 Form and Instruction 1
Health Center Program Support Customer Service Survey Modified 800 40 0 Form and Instruction 1
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Modified 2230 209 0 Form 1
Form 2
Form 3
Form 4
Form 5
Form 6
Form 7
Form 8
Form 9
Form 10
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Modified 665 70 0 Form 1
Form 2
Form and Instruction 3
Maternal, Infant, and Early Childhood Home Visiting Program On-Site Compliance Review Awardee Feedback Form Modified 315 79 0 Form 1
Maternal, Infant, and Early Childhood Home Visiting Site Visit Awardee Feedback Form Modified 270 68 0 Form and Instruction 1
Form and Instruction A
National Marrow Donor Program Donation Experience Survey Modified 1672 217 0 Form and Instruction 1
National Maternal Mental Health Hotline Modified 33000 9660 0 Instruction
Other-Data Dictionary
National Practitioner Data Bank Usability Survey Modified 200 200 0 Form and Instruction 1
Technical Assistance to Support the HHS Viral Hepatitis National Strategic Plan Modified 25 25 0 Other-Interview Questions
Title V Information System User Satisfaction Survey Modified 70 12 0 Form and Instruction 1
Tree Testing of HRSA's Ryan White HIV/AIDS Program website Modified 50 25 0 Other-Tree Test Plan
Form 1
Total burden requested under this ICR: 123961 15274 0  
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