Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys

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

Documents and Forms

Document Name Document Type
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form
1 Annual Awardee Survey Instrument A_Annual Awardee Survey.docx Form
1 Annual Awardee Survey Instrument A_Annual Awardee Survey.docx Form
2 Instrument B_Post Webinar Survey Instrument B_Post Webinar Survey.docx Form
2 Instrument B_Post Webinar Survey Instrument B_Post Webinar Survey.docx Form
3 Post Learning Collaborative Survey Instrument C_Post Learning Collaborative Survey.docx Form and Instruction
3 Post Learning Collaborative Survey Instrument C_Post Learning Collaborative Survey.docx Form and Instruction
Fast track memo.ITAC Satisfaction Surveys.docx Original Generic Request IC Document
Fast track memo.ITAC Satisfaction Surveys.docx Original Generic Request IC Document

Information Collection (IC) Details

IC Title:	Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	Annual Awardee Survey	Instrument A_Annual Awardee Survey.docx	Yes	Yes	Fillable Fileable
Form	2	Instrument B_Post Webinar Survey	Instrument B_Post Webinar Survey.docx	Yes	Yes	Fillable Fileable
Form and Instruction	3	Post Learning Collaborative Survey	Instrument C_Post Learning Collaborative Survey.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 665	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	665	665
Annual IC Time Burden (Hours)	70	70
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Original Generic Request	Fast track memo.ITAC Satisfaction Surveys.docx	01/09/2024

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