Healthy Start Program Survey Instruments

Healthy Start Evaluation and Capacity Building Support

OMB: 0906-0076

IC ID: 257575

Documents and Forms
Document Name
Document Type
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Healthy Start Program Survey Instruments
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Instruction Attachment A2_HS Recruitment Email Program Survey.docx Yes Yes Fillable Fileable
Instruction NSC A3_HS Recruitment Email Network Survey_8.28.23.docx Yes Yes Fillable Fileable
Instruction Attachment A4_HS Recruitment Email Participant Survey.docx Yes Yes Fillable Fileable
Instruction Attachment A5_HS Recruitment Email Participant Survey-Spanish.docx Yes Yes Fillable Fileable
Instruction Attachment A6_HS Recruitment Email Stakeholder Interview Guide.docx Yes Yes Fillable Fileable
Form and Instruction 1 Program Survey Attachment B1_HS Program Survey (003).docx Yes Yes Fillable Fileable
Form and Instruction 2 Network Survey NSC Version Attachment B2-HS Network Survey_082823.docx Yes Yes Fillable Fileable
Form and Instruction 3 Participant Survey Attachment B3_HS Participant Survey.docx Yes Yes Fillable Fileable
Form and Instruction 5 Stakeholder Interview Attachment B5_HS Stakeholder Interview Guide.docx Yes Yes Fillable Fileable
Form and Instruction 4 Participant Survey Spanish Attachment B4_HS Participant Survey-Spanish.docx Yes Yes Fillable Fileable
Form and Instruction 6 Results and Recommendations Attachment B6_Pilot Survey Results and Recommendations.docx Yes Yes Fillable Fileable
Instruction Attachment B7_HS Program Survey_FAQs.docx Yes Yes Fillable Fileable
Instruction Attachment B8_HS Network Survey_FAQs.docx Yes Yes Fillable Fileable

Health Health Care Services

 

1,601 0
   
State, Local, and Tribal Governments
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,601 0 0 0 0 1,601
Annual IC Time Burden (Hours) 600 0 0 0 0 600
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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