View Information Collection Request (ICR) Package
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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:
201206-0915-002
Status:
Historical Active
Previous ICR Reference No:
200904-0915-002
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:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
07/16/2012
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/08/2012
Terms of Clearance:
The agency is reminded that individual packages submitted under this generic clearance must be reviewed and approved by OMB prior to fielding. OMB will seek to review surveys within 10 days of submission. Packages submitted under this clearance will be used solely for purposes of measuring customer satisfaction.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
07/31/2015
36 Months From Approved
08/31/2012
Responses
52,250
0
52,050
Time Burden (Hours)
5,375
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:
77 FR 15111
03/14/2012
30-day Notice:
Federal Register Citation:
Citation Date:
77 FR 33224
06/05/2012
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
Bullying Prevention Training Modules Feedback Forms
A, B, C, D
Form A For Participants in the Bullying Prevention Modules Training 7 17
,
Form B Follow-Up Form For Participants in the Bullying Prevention Training Module 7-17
,
Form C For participants in Community_Events_7-17
,
Form D Follow-Up Form For Community Event Participant 7-17
CAREWare customer/user satisfaction
1
AREWare customer/user satisfaction
Confirmatory Typing Survey
1
Confirmatory Typing Survey
Customer Satisfaction Feedback of MIECHV Post-Award Grant Monitoring Process
1
customer satisfaction survey
DPDB Usability Studies
1, 2
Usability Testing Survey-Website Form
,
Usability Testing Survey-IQRS Form
HRSA Poison Help Campaign
1
Moderator's Guide
MAPP Satisfaction Survey
1
NACCHO MAPP training satisfaction survey
MIECHV TACC Needs Assessment Survey
1
TACC Needs Assessment
Maternal and Child Health Epidemiology Training Course One-Year Follow-up Survey
1
Maternal and Child Health Epidemiology Training Course One-Year Follow-up Survey
NHSC Virtual Job Fair Customer Feedback
1, 2
Site Feedback
,
Participant Survey
National Health Service Corps (NHSC) Virtual Job Fair Customer Feedback
2, 1
Site Feedback
,
Participant Feedback
Primary Care Faculty Development Initiative
1
PCFDI
Regions IV VI Infant Mortality Collaborative Improvement and Innovation Network (CoIIN) Participant Satisfaction Survey
1
Regions IV and VI Infant Mortality CoIIN Participant Satisfaction Survey
Technical Assistance provided to Ryan White HIV/AIDS Program Grantees
1, 2
Comprehensive Site Visit
,
non-comprehensive site visit
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
52,250
52,050
0
200
0
0
Annual Time Burden (Hours)
5,375
5,075
0
300
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
HRSA's renewal request includes the same number of burden hours for surveys and in-class evaluations as requested in the previous submission, which was approved by OMB. We are currently requesting to increase the number of focus group burden hours to accommodate new programs (mostly due to the Affordable Care Act) that would most appropriately be evaluated through the use or inclusion of focus groups within prospective evaluation data collection activities.
Annual Cost to Federal Government:
$700,000
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]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
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:
Jodi Duckhorn 301 443-1984
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:
06/08/2012
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