4 CQI Practicum Polls

OMB No: 0906-0084

Expiration date: 02/28/2027

CQI Practicum Polls

Public Burden Statement: The purpose of this information collection request is to assess participant satisfaction with various training and TA activities offered through a contracted TA provider, the Education Development Center. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0906-0084 and is valid until 02/28/2027. This information collection is voluntary. All responses will be aggregated and respondents will remain confidential. Public reporting burden for this collection of information is estimated to average .03 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Information Collection Clearance Officer, 5600 Fishers Lane, Room 14N39, Rockville, Maryland, 20857 or paperwork@hrsa.gov.

1. Do you plan to take an action step following this session?

   1. Yes

   2. No

2. [If yes] Please describe the action you will take. [Open text]

3. On a scale of 1 to 5, how helpful was this session in building your CQI knowledge and skills?

   1. 5 – Very helpful

   2. 4

   3. 3

   4. 2

   5. 1 – Not at all helpful

4. What worked really well today that you would like us to do more of or build on in future sessions? [Open text]

5. How can we make the next session even better? [Open text]