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:
0906-0084
ICR Reference No:
202402-0906-004
Status:
Historical Active
Previous ICR Reference No:
202401-0915-001
Agency/Subagency:
HHS/HRSA
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 without change
Conclusion Date:
02/26/2024
Retrieve Notice of Action (NOA)
Date Received in OIRA:
02/26/2024
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
02/28/2027
36 Months From Approved
Responses
98,000
0
69,250
Time Burden (Hours)
13,250
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:
88 FR 72494
10/20/2023
30-day Notice:
Federal Register Citation:
Citation Date:
89 FR 788
01/05/2024
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
27
IC Title
Form No.
Form Name
BPHC Customer Service Survey
1
Customer Feedback Survey
MIECHV TARC Satisfaction Survey
4, 1, 2, 3, 5, 6, 7, 9, 8, 10
Adaptive Leadership Academy Completion Survey
,
Community of Practice Survey Completion Survey
,
Practicum Check In Survey
,
CQI Practicum Polls
,
Individualized Targeted TA Check in
,
Small Group TA Closeout Survey
,
TARC Meeting Poll
,
Webinar Survey
,
CQI Practicum Completion Survey
,
Individualized Targeted TA
2024 Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Evaluation Surveys
1
Conference Evaluation Survey
2024 National Ryan White Conference on HIV Care & Treatment Evaluation
2, 3, 1
2024 NWRC Conference Session Questionaire
,
2024 Ryan White CEU Session Evaluation
,
Overall 2024 NRWC Conference Evaluation
Collection of Qualitative Feedback on Telehealth.HHS.gov
1, 2
Telehealth Website - Page Level - SurveyEngSpan
,
Telehealth Website - Site Level - Survey EngSpan
Collection of Qualitative Feedback on Telehealth.HHS.gov
1, 2
Website user (page-level survey)
,
Website user (site-wide survey)
DIR Objective Review Assessment Survey
2D, 2E, 2F, 3A, 3C, 3E, 3D, 3F, 3G, 3H, 1, 2, 3, 1A, 1B, 1C, 3B, 2B, 2C, 2A
Questions 1-5
,
Reviewer Evaluation Form
,
Reviewer Evaluation Field Review
,
Chair Reviewer Evaluation Q1-2
,
Chair Reviewer Evaluation Review Form Q3-4
,
Chair Reviewer Evaluation Review Q5
,
Reviewer Evaluation- Field Review Q1-2
,
Reviewer Evaluation- Field Review Q3-4
,
Reviewer Evaluation- Field Review Q5-6
,
Reviewer Evaluation- Field Review Q7-8
,
Reviewer Evaluation- Field Review Q9-10
,
Reviewer Evaluation- Field Review Q11-12
,
Reviewer Evaluation Q1-2
,
Reviewer Evaluation- Field Review Q3-4
,
Reviewer Evaluation- Field Review Q5-6
,
Reviewer Evaluation Q9-10
,
Reviewer Evaluation- Field Review Q7-8
,
Reviewer Evaluation- Field Review Q11-12
,
Reviewer Evaluation- Field Review Q13-14
,
Reviewer Evaluation- Field Review Q15
Division of Grants Management Operations Customer Service Satisfaction Survey
1
DGMO Customer Service Survey Questions
Division of Independent Review Objective Review Assessment Survey
1.1, 2, 1, 1.2
Screenshot Reviewer Instr
,
Form Chair Q 1-5
,
FORM Reviewer Evaluation Q 1- 15
,
FORM Reviewer Evaluation-Field Review Q 1 - 12
Division of Practitioner Data Bank (DPDB) Webinar Feedback and Satisfaction Surveys
1
Webinar Survey Questions
Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys
A, B, C, Attachment D
Attachment A_ECS TACC Community of Practice Surve
,
Attachment B_ECS TACC Webinar Survey
,
Attachment C_ECS TACC TA Resources Products Survey
,
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
1, 2
Query Survey Intro-Instructions
,
User Survey Questions - Query
Federal Cervical Cancer Collaborative (FCCC) CERV-Net Evaluation
1, 2, 3
CERV-Net 3-Month Follow-Up Test
,
CERV-Net Post-Test
,
CERV-Net Pre-Test
HRSA Electronic Handbooks Customer Service Survey
1
EHB Customer Support Center Survey Screenshot
HRSA Web Survey
2, 1
HRSA Web Survey
,
HRSA Web Survey (Spanish Language)
HRSA Web Survey
1, 2
English Language Survey
,
Spanish Language Survey
HRSA/HIV & AIDS Bureau (HAB) Recipients Satisfaction Survey (RSS).
1
HAB Recipients Satisfaction Survey
Health Center Program Support Customer Service Survey
1
EHBs Customer Support Center Survey Screenshot
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys
2, 1, 3
Annual Awardee Survey
,
Instrument B_Post Webinar Survey
,
Post Learning Collaborative Survey
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys
1, 2, 3, 4, 5, 6, 7, 8, 9, 10
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
,
CQI Practicum Completion Survey
Maternal, Infant, and Early Childhood Home Visiting Program On-Site Compliance Review Awardee Feedback Form
1
On Site Compliance Review Awardee Feedback Form
Maternal, Infant, and Early Childhood Home Visiting Site Visit Awardee Feedback Form
1, A
Instrument A MIECHV Site Visit Compliance Review Awardee Feedback Form Boilerplate
,
Instrument A MIECHV Site Visit Compliance Review Awardee Feedback Form
National Marrow Donor Program Donation Experience Survey
1
Donation Experience Survey
National Practitioner Data Bank Usability Survey
1
0915-0212_UsabiltyTesting Instrument_NPDBSystem
Technical Assistance to Support the HHS Viral Hepatitis National Strategic Plan
Title V Information System User Satisfaction Survey
1
Screen Shots of Title V Information System Survey 2021
Tree Testing of HRSA's Ryan White HIV/AIDS Program website
1
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
98,000
69,250
0
28,750
0
0
Annual Time Burden (Hours)
13,250
6,725
0
6,525
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 anticipates that the total burden of collections under this generic package will be 6,525 hours greater than under the prior approval for two reasons. First, HRSA is incorporating the additional burden amount approved for this ICR via a 2023 non-substantive change memo. Second, HRSA is accounting for upcoming efforts to get public input from a larger swath of HRSA’s partners in compliance with Executive Order 14058. HRSA has decreased its estimate of the average burden per response for surveys to account for the increasing use of telephone and online surveys, rather than mail-in surveys, since the latter are more time-consuming.
Annual Cost to Federal Government:
$249,390
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:
01/10/2024