Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration

ICR 202401-0915-001

OMB: 0915-0212

Federal Form Document

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0915-0212 can be found here:

2024-01-10 - Revision of a currently approved collection

Forms and Documents

Document Name	Status
Form 1 Evaluation Survey of Eligible National Practitioner Data Bank (NPDB) Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction	Unchanged
Form 1 Evaluation Survey of Eligible National Practitioner Data Bank (NPDB) Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction	Unchanged
Form 1 2024 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program All Grantee Meeting Evaluation Surveys Form	Unchanged
Form 1 2024 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program All Grantee Meeting Evaluation Surveys Form	Unchanged
Form 1 National Practitioner Data Bank (NPDB) Usability Survey Form and Instruction	Unchanged
Form 1 National Practitioner Data Bank (NPDB) Usability Survey Form and Instruction	Unchanged
Form 1 Trainee Ambassador Group Survey Form and Instruction	Unchanged
Form 1 Trainee Ambassador Group Survey Form and Instruction	Unchanged
Form 1 HRSA Web Survey Form	Unchanged
Form 1 HRSA Web Survey Form	Unchanged
Form 1 Customer Feedback Survey Form and Instruction	Unchanged
Form 1 Customer Feedback Survey Form and Instruction	Unchanged
Form 1 Listening Session Questions Form and Instruction	Unchanged
Form 1 Listening Session Questions Form and Instruction	Unchanged
Form 1 Primary Health Care Digest Newsletter Subscriber Survey Form and Instruction	Unchanged
Form 1 Primary Health Care Digest Newsletter Subscriber Survey Form and Instruction	Unchanged
Form 1 Tree Testing of HRSA's Ryan White HIV/AIDS Program website Form and Instruction	Unchanged
Form 1 Tree Testing of HRSA's Ryan White HIV/AIDS Program website Form and Instruction	Unchanged
Form 1 HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach (Online Focus Groups) Form and Instruction	Unchanged
Form 1 HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach (Online Focus Groups) Form and Instruction	Unchanged
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center (ITAC) Satisfaction Surveys Form	Unchanged
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center (ITAC) Satisfaction Surveys Form	Unchanged
Form 1 2022 National Ryan White Conference on HIV Care & Treatment Evaluation Form and Instruction	Unchanged
Form 1 2022 National Ryan White Conference on HIV Care & Treatment Evaluation Form and Instruction	Unchanged
Form 1 Be The Match Donation Experience Survey Form and Instruction	Modified
Form 1 Be The Match Donation Experience Survey Form and Instruction	Modified
Form 1 Federal Cervical Cancer Collaborative (FCCC) Post-Roundtable Evaluation Form and Instruction	Unchanged
Form 1 Federal Cervical Cancer Collaborative (FCCC) Post-Roundtable Evaluation Form and Instruction	Unchanged
Form A Early Childhood Systems Technical Assistance and Coordinating Center (ECS TACC) Customer Satisfaction Surveys Form	Unchanged
Form A Early Childhood Systems Technical Assistance and Coordinating Center (ECS TACC) Customer Satisfaction Surveys Form	Unchanged
Form 1 MCH Nutrition Training Needs Assessment Form and Instruction	Unchanged
Form 1 MCH Nutrition Training Needs Assessment Form and Instruction	Unchanged
Form 1 Organdonor.gov Website Survey Form and Instruction	Unchanged
Form 1 Organdonor.gov Website Survey Form and Instruction	Unchanged
Form 1 DGMO Customer Service Satisfaction Survey Form	Unchanged
Form 1 DGMO Customer Service Satisfaction Survey Form	Unchanged
Form 1 Health Center Program Support (HCPS) Customer Service Survey Form	Unchanged
Form 1 Health Center Program Support (HCPS) Customer Service Survey Form	Unchanged
Form 1 Collection of Qualitative Feedback on Telehealth.HHS.gov Form	Unchanged
Form 1 Collection of Qualitative Feedback on Telehealth.HHS.gov Form	Unchanged
Form 1 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program On-Site Compliance Review Awardee Feedback Form Form	Unchanged
Form 1 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program On-Site Compliance Review Awardee Feedback Form Form	Unchanged
Form 1 Title V Information System (TVIS) User Satisfaction Survey Form and Instruction	Unchanged
Form 1 Title V Information System (TVIS) User Satisfaction Survey Form and Instruction	Unchanged
Form 1 Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys Form	Unchanged
Form 1 Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys Form	Unchanged
Form 1 HRSA Electronic Handbooks Customer Service Survey Form and Instruction	Unchanged
Form 1 HRSA Electronic Handbooks Customer Service Survey Form and Instruction	Unchanged
12272023 - Memo to OMB - Non-Substantive Change Req.docx Justification for No Material/Nonsubstantive Change	2024-01-02
12272023 - Memo to OMB - Non-Substantive Change Req.docx Justification for No Material/Nonsubstantive Change	2024-01-02
Introductory message from NPDB FINAL_For Clearance.docx Justification for No Material/Nonsubstantive Change	2023-12-14
Introductory message from NPDB FINAL_For Clearance.docx Justification for No Material/Nonsubstantive Change	2023-12-14
NonSubstantive Change Request.docx Justification for No Material/Nonsubstantive Change	2023-12-14
NonSubstantive Change Request.docx Justification for No Material/Nonsubstantive Change	2023-12-14
0915-0212_NSC Memo FINAL.docx Justification for No Material/Nonsubstantive Change	2023-08-17
0915-0212_NSC Memo FINAL.docx Justification for No Material/Nonsubstantive Change	2023-08-17
Supporting Statement - part B.docx Supporting Statement B	2021-03-08
Supporting Statement - part B.docx Supporting Statement B	2021-03-08
Supporting Statement A FINAL.docx Supporting Statement A	2021-03-08
Supporting Statement A FINAL.docx Supporting Statement A	2021-03-08
Example0212 focus.doc Supplementary Document	2018-05-07
Example0212 focus.doc Supplementary Document	2018-05-07
Example Focus Group HSB.docx Supplementary Document	2018-05-07
Example Focus Group HSB.docx Supplementary Document	2018-05-07
Example Customer Survey OFAM.pdf Supplementary Document	2018-05-07
Example Customer Survey OFAM.pdf Supplementary Document	2018-05-07
Example Customer Survey BHW.pdf Supplementary Document	2018-05-07
Example Customer Survey BHW.pdf Supplementary Document	2018-05-07

IC Document Collections

IC ID	Document Title	Status
263816	Evaluation Survey of Eligible National Practitioner Data Bank (NPDB) Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction	Unchanged
263816	Evaluation Survey of Eligible National Practitioner Data Bank (NPDB) Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction	Unchanged
263615	2024 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program All Grantee Meeting Evaluation Surveys Form	Unchanged
263615	2024 Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program All Grantee Meeting Evaluation Surveys Form	Unchanged
263052	National Practitioner Data Bank (NPDB) Usability Survey Form and Instruction	Unchanged
263052	National Practitioner Data Bank (NPDB) Usability Survey Form and Instruction	Unchanged
262807	Trainee Ambassador Group Survey Form and Instruction	Unchanged
262807	Trainee Ambassador Group Survey Form and Instruction	Unchanged
262607	National Organ Donation Expert Opinion Survey Instruction	Unchanged
261675	HRSA Web Survey Form	Unchanged
261675	HRSA Web Survey Form	Unchanged
260381	Customer Feedback Survey Form and Instruction	Unchanged
260381	Customer Feedback Survey Form and Instruction	Unchanged
259969	Listening Session Questions Form and Instruction	Unchanged
259969	Listening Session Questions Form and Instruction	Unchanged
259876	Primary Health Care Digest Newsletter Subscriber Survey Form and Instruction	Unchanged
259876	Primary Health Care Digest Newsletter Subscriber Survey Form and Instruction	Unchanged
259711	Tree Testing of HRSA's Ryan White HIV/AIDS Program website Form and Instruction	Unchanged
259711	Tree Testing of HRSA's Ryan White HIV/AIDS Program website Form and Instruction	Unchanged
259277	Feedback and Lessons Learned from CBO Program Award Recipients Instruction	Unchanged
259013	HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach (Online Focus Groups) Form and Instruction	Unchanged
259013	HRSA Division of Transplantation (DoT) Formative Evaluation Minority Organ Donation Outreach (Online Focus Groups) Form and Instruction	Unchanged
258285	Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center (ITAC) Satisfaction Surveys Form	Unchanged
258285	Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center (ITAC) Satisfaction Surveys Form	Unchanged
254660	2022 National Ryan White Conference on HIV Care & Treatment Evaluation Form and Instruction	Unchanged
254660	2022 National Ryan White Conference on HIV Care & Treatment Evaluation Form and Instruction	Unchanged
253158	Health Center COVID-19 Vaccine Program (HCVP) After-Action Survey Instruction	Unchanged
252323	Be The Match Donation Experience Survey Form and Instruction	Modified
252323	Be The Match Donation Experience Survey Form and Instruction	Modified
252068	Federal Cervical Cancer Collaborative (FCCC) Post-Roundtable Evaluation Form and Instruction	Unchanged
252068	Federal Cervical Cancer Collaborative (FCCC) Post-Roundtable Evaluation Form and Instruction	Unchanged
250631	Early Childhood Systems Technical Assistance and Coordinating Center (ECS TACC) Customer Satisfaction Surveys Form	Unchanged
250631	Early Childhood Systems Technical Assistance and Coordinating Center (ECS TACC) Customer Satisfaction Surveys Form	Unchanged
250357	MCH Nutrition Training Needs Assessment Form and Instruction	Unchanged
250357	MCH Nutrition Training Needs Assessment Form and Instruction	Unchanged
248953	Organdonor.gov Website Survey Form and Instruction	Unchanged
248953	Organdonor.gov Website Survey Form and Instruction	Unchanged
248753	DGMO Customer Service Satisfaction Survey Form	Unchanged
248753	DGMO Customer Service Satisfaction Survey Form	Unchanged
248514	Health Center Program Support (HCPS) Customer Service Survey Form	Unchanged
248514	Health Center Program Support (HCPS) Customer Service Survey Form	Unchanged
248260	Collection of Qualitative Feedback on Telehealth.HHS.gov Form	Unchanged
248260	Collection of Qualitative Feedback on Telehealth.HHS.gov Form	Unchanged
247769	DIR Objective Review Assessment Survey Instruction	Unchanged
247472	Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program On-Site Compliance Review Awardee Feedback Form Form	Unchanged
247472	Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program On-Site Compliance Review Awardee Feedback Form Form	Unchanged
247059	Title V Information System (TVIS) User Satisfaction Survey Form and Instruction	Unchanged
247059	Title V Information System (TVIS) User Satisfaction Survey Form and Instruction	Unchanged
247043	Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys Form	Unchanged
247043	Maternal, Infant, and Early Childhood Home Visiting Program Technical Assistance Resource Center (TARC) Satisfaction Surveys Form	Unchanged
246973	HRSA Electronic Handbooks Customer Service Survey Form and Instruction	Unchanged
246973	HRSA Electronic Handbooks Customer Service Survey Form and Instruction	Unchanged

ICR Details