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

ICR 202503-0906-002

OMB: 0906-0084

Federal Form Document

Forms and Documents

Document Name	Status
Form 1 Follow up: ASPR/ Strategic National Stockpile (SNS) Dissemination and HRSA-Supported Health Centers use of JYNNEOS vaccine. Form	Unchanged
Form 1 Follow up: ASPR/ Strategic National Stockpile (SNS) Dissemination and HRSA-Supported Health Centers use of JYNNEOS vaccine. Form	Unchanged
Form 1 Expanding Health Center Awareness of Sexual Assault-Related Health Care Needs (SATA) Evaluation Form and Instruction	Unchanged
Form 1 Expanding Health Center Awareness of Sexual Assault-Related Health Care Needs (SATA) Evaluation Form and Instruction	Unchanged
Form 1 HRSA/HIV & AIDS Bureau (HAB) Recipients Satisfaction Survey (RSS). Form and Instruction	Unchanged
Form 1 HRSA/HIV & AIDS Bureau (HAB) Recipients Satisfaction Survey (RSS). Form and Instruction	Unchanged
Form 1 Division of Practitioner Data Bank (DPDB) Webinar Feedback and Satisfaction Surveys Form	Unchanged
Form 1 Division of Practitioner Data Bank (DPDB) Webinar Feedback and Satisfaction Surveys Form	Unchanged
Form 1 BPHC Customer Service Survey Form and Instruction	Unchanged
Form 1 BPHC Customer Service Survey Form and Instruction	Unchanged
Form 2 2024 National Ryan White Conference on HIV Care & Treatment Evaluation Form	Unchanged
Form 2 2024 National Ryan White Conference on HIV Care & Treatment Evaluation Form	Unchanged
Form 1 HRSA Web Survey Form	Unchanged
Form 1 HRSA Web Survey Form	Unchanged
Form 1 MIECHV TARC Satisfaction Survey Form and Instruction	Unchanged
Form 1 MIECHV TARC Satisfaction Survey Form and Instruction	Unchanged
Form 1 Federal Cervical Cancer Collaborative (FCCC) CERV-Net Evaluation Form and Instruction	Unchanged
Form 1 Federal Cervical Cancer Collaborative (FCCC) CERV-Net Evaluation Form and Instruction	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 HRSA Web Survey Form	Unchanged
Form 1 HRSA Web Survey Form	Unchanged
Form 1 Title V Information System User Satisfaction Survey Form and Instruction	Unchanged
Form 1 Title V Information System User Satisfaction Survey Form and Instruction	Unchanged
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form	Unchanged
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form	Unchanged
Form 1 Collection of Qualitative Feedback on Telehealth.HHS.gov Form and Instruction	Unchanged
Form 1 Collection of Qualitative Feedback on Telehealth.HHS.gov Form and Instruction	Unchanged
Form 1 National Practitioner Data Bank Usability Survey Form and Instruction	Unchanged
Form 1 National Practitioner Data Bank Usability Survey Form and Instruction	Unchanged
Form 1 Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction	Unchanged
Form 1 Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction	Unchanged
Form 1 National Marrow Donor Program Donation Experience Survey Form and Instruction	Unchanged
Form 1 National Marrow Donor Program Donation Experience Survey Form and Instruction	Unchanged
Form 1 Maternal, Infant, and Early Childhood Home Visiting Site Visit Awardee Feedback Form Form and Instruction	Unchanged
Form 1 Maternal, Infant, and Early Childhood Home Visiting Site Visit Awardee Feedback Form Form and Instruction	Unchanged
Form 1 Maternal, Infant, and Early Childhood Home Visiting Program On-Site Compliance Review Awardee Feedback Form Form	Unchanged
Form 1 Maternal, Infant, and Early Childhood Home Visiting Program On-Site Compliance Review Awardee Feedback Form Form	Unchanged
Form 1 2024 Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Evaluation Surveys Form	Unchanged
Form 1 2024 Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Evaluation Surveys Form	Unchanged
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form	Unchanged
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form	Unchanged
Form 1 Health Center Program Support Customer Service Survey Form and Instruction	Unchanged
Form 1 Health Center Program Support Customer Service Survey Form and Instruction	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
Form A Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys Form and Instruction	Unchanged
Form A Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys Form and Instruction	Unchanged
Form 1.1 Division of Independent Review Objective Review Assessment Survey Form and Instruction	Unchanged
Form 1.1 Division of Independent Review Objective Review Assessment Survey Form and Instruction	Unchanged
Form 1 Division of Grants Management Operations Customer Service Satisfaction Survey Form	Unchanged
Form 1 Division of Grants Management Operations Customer Service Satisfaction Survey Form	Unchanged
0906-0084_MCHB_OMB NonSubstantive Change Request_03052025.docx Justification for No Material/Nonsubstantive Change	2025-03-14
0906-0084_MCHB_OMB NonSubstantive Change Request_03052025.docx Justification for No Material/Nonsubstantive Change	2025-03-14
0906 0084_NSC Memo.docx Justification for No Material/Nonsubstantive Change	2024-06-28
0906 0084_NSC Memo.docx Justification for No Material/Nonsubstantive Change	2024-06-28
Focus Group Example_Screening Questions.docx Supplementary Document	2024-01-09
Focus Group Example_Screening Questions.docx Supplementary Document	2024-01-09
Focus Group Example_Informed Consent.docx Supplementary Document	2024-01-09
Focus Group Example_Informed Consent.docx Supplementary Document	2024-01-09
Focus Group Example_Focus Group Guide.docx Supplementary Document	2024-01-09
Focus Group Example_Focus Group Guide.docx Supplementary Document	2024-01-09
Supporting Statement B 12.8.23.docx Supporting Statement B	2024-01-09
Supporting Statement B 12.8.23.docx Supporting Statement B	2024-01-09
Supporting Statement A 12.8.23.docx Supporting Statement A	2024-01-09
Supporting Statement A 12.8.23.docx Supporting Statement A	2024-01-09

IC Document Collections

IC ID	Document Title	Status
271634	Follow up: ASPR/ Strategic National Stockpile (SNS) Dissemination and HRSA-Supported Health Centers use of JYNNEOS vaccine. Form	Unchanged
271634	Follow up: ASPR/ Strategic National Stockpile (SNS) Dissemination and HRSA-Supported Health Centers use of JYNNEOS vaccine. Form	Unchanged
271017	National Maternal Mental Health Hotline Instruction	Modified
270921	Expanding Health Center Awareness of Sexual Assault-Related Health Care Needs (SATA) Evaluation Form and Instruction	Unchanged
270921	Expanding Health Center Awareness of Sexual Assault-Related Health Care Needs (SATA) Evaluation Form and Instruction	Unchanged
268809	Technical Assistance to Support the HHS Viral Hepatitis National Strategic Plan Other-Interview Questions	Unchanged
267884	HRSA/HIV & AIDS Bureau (HAB) Recipients Satisfaction Survey (RSS). Form and Instruction	Unchanged
267884	HRSA/HIV & AIDS Bureau (HAB) Recipients Satisfaction Survey (RSS). Form and Instruction	Unchanged
267569	Division of Practitioner Data Bank (DPDB) Webinar Feedback and Satisfaction Surveys Form	Unchanged
267569	Division of Practitioner Data Bank (DPDB) Webinar Feedback and Satisfaction Surveys Form	Unchanged
266289	BPHC Customer Service Survey Form and Instruction	Unchanged
266289	BPHC Customer Service Survey Form and Instruction	Unchanged
266140	2024 National Ryan White Conference on HIV Care & Treatment Evaluation Form	Unchanged
266140	2024 National Ryan White Conference on HIV Care & Treatment Evaluation Form	Unchanged
266005	HRSA Web Survey Form	Unchanged
266005	HRSA Web Survey Form	Unchanged
265734	MIECHV TARC Satisfaction Survey Form and Instruction	Unchanged
265734	MIECHV TARC Satisfaction Survey Form and Instruction	Unchanged
265672	DIR Objective Review Assessment Survey Instruction	Unchanged
265627	Federal Cervical Cancer Collaborative (FCCC) CERV-Net Evaluation Form and Instruction	Unchanged
265627	Federal Cervical Cancer Collaborative (FCCC) CERV-Net Evaluation Form and Instruction	Unchanged
265626	Collection of Qualitative Feedback on Telehealth.HHS.gov Form	Unchanged
265626	Collection of Qualitative Feedback on Telehealth.HHS.gov Form	Unchanged
264362	HRSA Web Survey Form	Unchanged
264362	HRSA Web Survey Form	Unchanged
264361	Title V Information System User Satisfaction Survey Form and Instruction	Unchanged
264361	Title V Information System User Satisfaction Survey Form and Instruction	Unchanged
264360	Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form	Unchanged
264360	Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form	Unchanged
264359	Tree Testing of HRSA's Ryan White HIV/AIDS Program website Other-Tree Test Plan	Unchanged
264357	Collection of Qualitative Feedback on Telehealth.HHS.gov Form and Instruction	Unchanged
264357	Collection of Qualitative Feedback on Telehealth.HHS.gov Form and Instruction	Unchanged
264355	National Practitioner Data Bank Usability Survey Form and Instruction	Unchanged
264355	National Practitioner Data Bank Usability Survey Form and Instruction	Unchanged
264354	Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction	Unchanged
264354	Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction	Unchanged
264353	National Marrow Donor Program Donation Experience Survey Form and Instruction	Unchanged
264353	National Marrow Donor Program Donation Experience Survey Form and Instruction	Unchanged
264352	Maternal, Infant, and Early Childhood Home Visiting Site Visit Awardee Feedback Form Form and Instruction	Unchanged
264352	Maternal, Infant, and Early Childhood Home Visiting Site Visit Awardee Feedback Form Form and Instruction	Unchanged
264351	Maternal, Infant, and Early Childhood Home Visiting Program On-Site Compliance Review Awardee Feedback Form Form	Unchanged
264351	Maternal, Infant, and Early Childhood Home Visiting Program On-Site Compliance Review Awardee Feedback Form Form	Unchanged
264349	2024 Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Evaluation Surveys Form	Unchanged
264349	2024 Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Evaluation Surveys Form	Unchanged
264348	Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form	Unchanged
264348	Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form	Unchanged
264347	Health Center Program Support Customer Service Survey Form and Instruction	Unchanged
264347	Health Center Program Support Customer Service Survey Form and Instruction	Unchanged
264346	HRSA Electronic Handbooks Customer Service Survey Form and Instruction	Unchanged
264346	HRSA Electronic Handbooks Customer Service Survey Form and Instruction	Unchanged
264345	Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys Form and Instruction	Unchanged
264345	Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys Form and Instruction	Unchanged
264344	Division of Independent Review Objective Review Assessment Survey Form and Instruction	Unchanged
264344	Division of Independent Review Objective Review Assessment Survey Form and Instruction	Unchanged
264342	Division of Grants Management Operations Customer Service Satisfaction Survey Form	Unchanged
264342	Division of Grants Management Operations Customer Service Satisfaction Survey Form	Unchanged

ICR Details