Form 2 Grantee Follow-up Survey

Attachment 3: RPHWTNP Grantee Follow-up Survey
Question
No.

Question

Skip Logic

Response Options

Required

Valid Response
Restriction

This survey is designed to collect follow-up data from grantees that have been awarded funds for the Rural Public Health Workforce Training Network
Program (RPHWTNP) through the Health Resources and Services Administration (HRSA). The following questions will ask information about ongoing program
activities. Data should be entered biannually throughout the period of performance. Information collected from this survey will be utilized by the Federal
Office of Rural Health Policy (FORHP) to understand a snapshot of your program activities. Should you have any questions regarding this survey, please direct
your questions to your HRSA Project Officer.
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 information collection is 0915/0906-XXXX and it is valid until XX/XX/202X. This information collection is required
to obtain or retain a benefit (42 U.S.C. § 254c(f) (§ 330A(f) of the Public Health Service Act); Section 2501 of the American Rescue Plan Act of 2021 (P.L. 1172) via the following funding opportunity: HRSA-22-117). Public reporting burden for this collection of information is estimated to average 0.125 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
Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857 or paperwork@hrsa.gov.
General
1
2

What is the name of your lead grantee
organization?
Which workforce training track(s) has/have
been selected for this program?

Consortium (Training Network)
General
Text

Drop-down (32 grantees)

*

Matrix response, 5 tracks x 3 columns:
formally selected in application, informally
selected, N/A

*

The following questions will ask about information relating to the training network, or consortium, that your organization has created/ is
creating for the RPHWTNP.
Internal consortium members are organizations that have signed a memorandum of understanding, or MOU, with the lead grantee organization
for the purposes of the RPHWTNP.
External consortium members are organizations that have not signed a MOU, but will work with the lead grantee organization in some capacity
for the purposes of the RPHWTNP.

3

How many total (both internal and external)
network organizations/ entities, or consortium
members, are currently involved in this
organizations training network? Please enter a
numeric value.

Free-text

*

numeric, 1-1000

Training
General
Text

4

5

6

The following questions will ask about information relating to the trainings that are provided through the Rural Public Health Workforce
Training Network program. Training is defined as competency-based high-quality education, training, and other services, that:
a.) aligns with the skill needs of the workforce training tracks identified in the Rural Public Health Workforce Training Network Program
(RPHWTNP);
b.) prepares an individual (trainee) to be successful in any of a full range of secondary or postsecondary education options, including
apprenticeships;
c.) includes, as appropriate, education offered concurrently with and in the same context as workforce preparation activities and training for a
specific occupation or occupational cluster;
d.) organizes education, training, and other services that are culturally and linguistically competent to meet the particular needs of an individual
(trainee) in a manner that accelerates the educational and career advancement of the individual (trainee) to the extent practicable;
e.) helps an individual (trainee) enter or advance within a specific occupation or occupational cluster as listed in the RPHWTNP.
For the purposes of this survey, a "training" refers to a type of content-based training and not a unit of training or format of training. (e.g., If a
consortium is providing a motivational interviewing training on Monday’s, Wednesday’s, and Thursday’s, this is considered as one training. If a
consortium is providing a motivational interviewing training in person on Monday, virtually on Wednesday, and in person on Friday, this is still
considered as one training.)
To date, how many trainings have been offered
free-text matrix response, 5 tracks (Track 1:
*
Numeric only
through the RPHWTNP? (Please enter a
Community Health Support, Track 2: Health
number in each box.)
IT and/or Technical Support, Track 3:
Community Paramedicine, Track 4a: Case
Management, Track 4b: Respiratory
Therapists) x 3 columns (Formally selected in
application, Informally selected, Not
applicable/Not selected)
To date, which of the following topics has your
Multi-select, 20 options from training list
*
consortium offered trainings for through the
RPHWTNP? (Please select all that apply).
Are there additional trainings that have been
offered by your consortium not listed in the
previous options?

No

*

Yes, our consortium has offered trainings on
additional topics such as (please enter 1
training per line):

Attachment 3: RPHWTNP Grantee Follow-up Survey

7

What types of credentials or certificates have
been awarded for the trainings offered to
date?

Associate Degree (please specify): [free-text]

*

Billing and Coding Specialist
Certified Doula: Birth Doula, Antepartum
Doula, Postpartum Doula, End of Life Doula
Certified Health Care Interpreter
Certified Nurse Assistant
Certified Respiratory Therapist (CRT) /
Registered Respiratory Therapist
Clincal Medical Assistant/ Certified Medical
Assistant
Community Health Worker certification
Electronic Health Records (EHR) Specialist
EMT: Basic, Intermediate, Advanced, General
(no specific level)
Paramedic/ Mobile Integrated Health
Patient Navigator and/or Peer Support
Specialist certification
Pulmonary Rehabilitation Certificate
Something else: Please specify [free-text]
None of the above.
Trainees
General
Text

The following questions will ask about information relating to the types of individuals that trainings are available to within the RPHWTNP.

8

To date, how many trainees have completed
trainings that have been offered through the
RPHWTNP?

9

How many of the following individuals has the
consortium made trainings available to in the
tracks selected?

Free-text Matrix response, 5 tracks x 3
columns: formally selected in application,
informally selected, N/A

*

Numeric only

*

Attachment 3: RPHWTNP Grantee Follow-up Survey

a. currently employed individuals

Matrix: Individual type (currently employed
individuals, non-employed individuals) x
track selected (within consortium, outside of
consortium).

Numeric only

b. non-employed individuals

Matrix: Individual type (currently employed
individuals, non-employed individuals) x
track selected (within consortium, outside of
consortium).

Numeric only

Access & Equity
10

11

Costs
General
Text
12

To date, what languages have trainings be
offered in?
To date, what modalities have trainings been
offered in?

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Q12
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Q11

Multi-select. English, Spanish

*

Not listed here
Multi-select + Free-text; web-based (live),
web-based (self-paced), in-person, other
(please indicate all languages that you do not
see an option for above)

*

The following questions will ask about information relating to costs associated for trainings administered through training networks within the
RPHWTNP.
Out of the funding received from HRSA, has
your organization provided any of the following
to one or more individuals enrolled in this
program to date?
(Select all that apply.)

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Q13
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Q14
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Q14
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Q14
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Q14
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Q14
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Q14
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Q14

Scholarships for trainings

*

Transportation
Childcare
Food assistance
Internet/ Internet access
Equipment (computer, headphones, tablets,
etc.)
Other. Please specify [ free-text]
None of the above has/have been provided
to any individuals in the RPHWTNP to date.
Attachment 3: RPHWTNP Grantee Follow-up Survey

13
Funding
General
Text
14

What is the total amount of funding ($) in
scholarships that your organization has
distributed?

Free-text

Numeric only

The following questions will ask about information relating to funding, and funding sources, for your activities within the RPHWTNP.
Is HRSA the primary funding source your
organization will utilize to implement this
program?

Yes

*

No

Attachment 3: RPHWTNP Grantee Follow-up Survey