OMB Control No: 0906-0084
ICR Reference No:
202406-0906-005
Status: Active
Previous ICR Reference No: 202402-0906-004
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: No
material or nonsubstantive change to a currently approved
collection
Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved
without change
Conclusion Date: 07/08/2024
Retrieve
Notice of Action (NOA)
Date Received in OIRA:
06/28/2024
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
02/28/2027
02/28/2027
02/28/2027
Responses
136,977
0
98,000
Time Burden (Hours)
15,045
0
13,250
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
1, 2, 3, 4, 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
Website user
(page-level survey) , Website user (site-wide
survey)
Collection of
Qualitative Feedback on Telehealth.HHS.gov
1, 2
Telehealth Website
- Page Level - SurveyEngSpan , Telehealth Website - Site
Level - Survey EngSpan
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
1, 2
English Language
Survey , Spanish Language
Survey
HRSA Web
Survey
2, 1
HRSA Web
Survey , HRSA Web Survey (Spanish
Language)
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
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 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 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
136,977
98,000
0
38,977
0
0
Annual Time Burden (Hours)
15,045
13,250
0
1,795
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 is requesting an increase
in increase the number of responses and burden hours, due to an
error that occurred when HRSA renewed this umbrella ICR in
February. When HRSA revised this ICR in February, it updated five
of its renewed information collections (ICs), resulting in the ICs
having their hours deducted from the ICR twice. This error means
that approximately 40% of the respondent budget and 14% of the
burden hour budget are used on outdated collections. Since the
ROCIS functionality does not allow HRSA to discontinue individual
ICs within a larger Umbrella ICR, HRSA is requesting an increase of
38,977 respondents and 1,795 burden hours so that HRSA can use the
Umbrella ICR, as HRSA had originally planned.
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