View Information Collection Request (ICR) Package
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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:
202401-0915-001
Status:
Historical Active
Previous ICR Reference No:
202312-0915-001
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:
No material or nonsubstantive change to a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
01/05/2024
Retrieve Notice of Action (NOA)
Date Received in OIRA:
01/04/2024
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
04/30/2024
04/30/2024
04/30/2024
Responses
69,250
0
69,250
Time Burden (Hours)
6,725
0
6,725
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:
85 FR 81210
12/15/2020
30-day Notice:
Federal Register Citation:
Citation Date:
86 FR 14462
03/16/2021
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
28
IC Title
Form No.
Form Name
MCH Nutrition Training Needs Assessment
1
Survey 2022 MCH Nutrition Training Needs Assessment_10.29.21.docx
2022 National Ryan White Conference on HIV Care & Treatment Evaluation
1, 2, 3, 4
Conference Plenary Session Evaluation
,
Conference Breakout Session Evaluation
,
CEU Breakout Session Evaluation
,
Conference (Overall) Evaluation
2024 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program All Grantee Meeting Evaluation Surveys
1, 2, 3, 4
Conference Evaluation Survey
,
Plenary Session Evaluation Survey
,
Concurrent Session Evaluation Survey
,
AGM Poster Session Evaluation Survey
Be The Match Donation Experience Survey
1, 1A, 1B
BTM Donation Experience Survey - CLEAN.docx
,
Donation Experience Survey
,
12272023 - Attachment A - Redline
Collection of Qualitative Feedback on Telehealth.HHS.gov
1, 2
Telehealth Website - Page Level - SurveyEngSpan.docx
,
Telehealth Website - Site Level - Survey EngSpan.docx
Customer Feedback Survey
1
Customer Feedback Survey
DGMO Customer Service Satisfaction Survey
1
DGMO Customer Service Survey Questions.docx
DIR Objective Review Assessment Survey
1, 1.2, 2
Reviewer Evaluation Q 1- 15.pdf
,
Reviewer Evaluation-Field Review Q 1 - 12.pdf
,
FORM CHAIR Q 1-5.pdf
Early Childhood Systems Technical Assistance and Coordinating Center (ECS TACC) Customer Satisfaction Surveys
A, B, C, D
Attachment A_ECS TACC Community of Practice Survey.docx
,
Attachment B_ECS TACC Webinar Survey.docx
,
Attachment C_ECS TACC TA Resources Products Survey.docx
,
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
1
User Survey Questions-Query FINAL For Clearance
Federal Cervical Cancer Collaborative (FCCC) Post-Roundtable Evaluation
1
Post-Roundtable-Survey_V02-Final.pdf
Feedback and Lessons Learned from CBO Program Award Recipients
HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach (Online Focus Groups)
1, 3, 2
Focus Group Moderators Guide
,
Informed Consent
,
Screening Questions
HRSA Electronic Handbooks Customer Service Survey
1
EHBs Customer Support Center Survey Screenshot.docx
HRSA Web Survey
1, 2
English Version_HRSA Web Survey
,
Spanish Version_HRSA Web Survey
Health Center COVID-19 Vaccine Program (HCVP) After-Action Survey
Health Center Program Support (HCPS) Customer Service Survey
1
HCPS - 2021 Sample Customer Service Survey--Salesforce In Sandbox.docx
Listening Session Questions
1
Listening Session Questions
Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program On-Site Compliance Review Awardee Feedback 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
2, 1, 3
Annual Awardee Survey
,
Post Webinar Survey
,
Post Learning Collaborative Survey
Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys
6, 9, 10, 5, 3, 4, 7, 8, 1, 2
Attachment A_Individualized Targeted TA Check in
,
Attachment B_Individualized Targeted TA Closeout
,
Attachment C_Project Officer Survey
,
Attachment D_Webinar Survey
,
Attachment E_Community of Practice Survey
,
Attachment F_Leadership Academy Session Survey
,
Attachment G_Leadership Academy Completion Survey
,
Attachment H_Quarterly Overall TA Survey
,
Attachment I_CQI Practicum Check in Survey
,
Attachment J_CQI Practicum Completion Survey
National Organ Donation Expert Opinion Survey
National Practitioner Data Bank (NPDB) Usability Survey
1
National Practitioner Data Bank (NPDB) Usability Survey
Organdonor.gov Website Survey
1
HRSA DoT Organdonor.gov Website Survey Questionnaire.docx
Primary Health Care Digest Newsletter Subscriber Survey
1
Primary Health Care Digest Newsletter Subscriber Survey
Title V Information System (TVIS) User Satisfaction Survey
1
Screen Shots of Title V Information System Survey 2021
Trainee Ambassador Group Survey
1
Trainee Ambassador Group Survey
Tree Testing of HRSA's Ryan White HIV/AIDS Program website
1, 1
Tree Test Plan
,
Tree Test Script
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
69,250
69,250
0
0
0
0
Annual Time Burden (Hours)
6,725
6,725
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:
There has been an increase in interest in the use of fast-track generic packages within HRSA. As a result, HRSA has seen increased use of the burden hours and responses in the original ICR.As a result, HRSA is requesting an increase in 17,000 responses and 1,000 burden hours to allow HRSA to continue to use this generic umbrella ICR as necessary. HRSA is not requesting changes to the instruments currently approved at this time. We have already alerted our desk office.
Annual Cost to Federal Government:
$700,000
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Does this ICR request any personally identifiable information (see
OMB Circular No. A-130
for an explanation of this term)? Please consult with your agency's privacy program when making this determination.
No
Does this ICR include a form that requires a Privacy Act Statement (see
5 U.S.C. §552a(e)(3)
)? Please consult with your agency's privacy program when making this determination.
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?
No
Agency Contact:
Elyana Bowman 301 443-3983 enadjem@hrsa.gov
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:
01/04/2024