View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View Generic ICR - OIRA Conclusion
OMB Control No:
0915-0212
ICR Reference No:
200904-0915-002
Status:
Historical Active
Previous ICR Reference No:
200809-0915-001
Agency/Subagency:
HHS/HSA
Agency Tracking No:
Title:
Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
08/14/2009
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/27/2009
Terms of Clearance:
Previous terms of clearance remain in effect.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2012
36 Months From Approved
08/31/2009
Responses
52,050
0
52,050
Time Burden (Hours)
5,075
0
5,075
Cost Burden (Dollars)
0
0
0
Abstract:
This generic project clearance allows HRSA to conduct voluntary customer satisfaction surveys of its partners to assess strengths and weaknesses in program services and products. Examples of such surveys include satisfaction with technical assistance provided to grantees, in class evaluations of training sessions, and satisfaction with information services.
Authorizing Statute(s):
EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
73 FR 23472
04/30/2008
30-day Notice:
Federal Register Citation:
Citation Date:
74 FR 18726
04/24/2009
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
14
IC Title
Form No.
Form Name
Area Resource File User Survey
1
ARF User Survey
BCRS Collegiate Health Service Corps Survey
CHSC1
CHSC Survey
BCRS NELRP and NSP Focus Groups
1, 2, 3, 4
IDI Moderator Guide Nurses Administrators et al Creative Exploratory
,
In Person Moderator Guide Nurses Prospects Creative Exploratory
,
Online Focus Group Guide Nursing Current Participants
,
Online Focus Group Guide Nursing Prospective Applicants
BHPr Funding Strategy Evaluation
PCRE-1, PCRE-2, PCRE-3
PCRE Eligible Funded
,
PCRE-Eligible Inquiry Did Not Apply
,
PCRE-Eligible No Inquiry Did Not Apply
BHPr Funding Strategy Evaluation - Applicants who did not receive funding
PCRE-1
PCRE Survey - Eligible, Applied but not funded
BHPr Funding Strategy Evaluation- Expansion of Physician Assistant Training
1, 2, 3
EPAT Eligible Funded
,
EPAT- Eligible Inquiry Did Not Apply
,
EPAT- Eligible No Inquiry Did Not Apply
HRSA Division of Transplantation Qualitative Assessment of Outreach Materials
1, 2, 3, 4
Screener Interview
,
Screener focusgroup
,
Interview Guide
,
Focus Group Guide
HRSA Information Center Live Help Online
001_OCIC
001_OCIC
HRSA Quality Toolkit Survey
QI 1
Quality Toolkit Survey
National Health Service Corps (NHSC) Brand and Materials Feedback
Attachment C, Attachment B, Attachment A, Attachment D
Consent Form
,
Focus Group Moderator's Guide
,
Focus Group Recruitment Screener
,
NHSC Brand Materials Survey
New Freedom Initiative Caregiver Broadcast Survey
NFI 2009
NFI Survey
OFAM Customer Satisfaction Survey
1
Customer Survey
OFAM Grants Management Customer Service Survey
1
Customer Satisfaction Survey
Women's Health USA and Child Health USA User Satisfaction Surveys
001_CHUSA, 001_WHUSA
001_CHUSA
,
001_WHUSA
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
52,050
52,050
0
0
0
0
Annual Time Burden (Hours)
5,075
5,075
0
0
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$0
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Susan Queen 3014431129
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
04/27/2009
An official website of the United States government
The .gov means it's official.
The site is secure.
