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

OMB 0915-0212

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.

The latest form for Voluntary Partner Surveys to Implement Executive Order 12862 in the Health Resources and Services Administration expires 2021-07-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 1 HRSA Web Survey Form
Form 1 Title V Information System User Satisfaction Survey Form and Instruction
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form
Form 1 Collection of Qualitative Feedback on Telehealth.HHS.gov Form and Instruction
Form 1 National Practitioner Data Bank Usability Survey Form and Instruction
Form 1 Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction
Form 1 National Marrow Donor Program Donation Experience Survey Form and Instruction
Form 1 Maternal, Infant, and Early Childhood Home Visiting Site Visit Awardee Feedback Form Form and Instruction
Form 1 Maternal, Infant, and Early Childhood Home Visiting Program On-Site Compliance Review Awardee Feedback Form Form
Form 1 2024 Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Evaluation Surveys Form
Form 1 Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form
Form 1 Health Center Program Support Customer Service Survey Form and Instruction
Form 1 HRSA Electronic Handbooks Customer Service Survey Form and Instruction
Form A Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys Form and Instruction
Form 1.1 Division of Independent Review Objective Review Assessment Survey Form and Instruction
Form 1 Division of Grants Management Operations Customer Service Satisfaction Survey Form
Focus Group Example_Screening Questions.docx Supplementary Document
Focus Group Example_Informed Consent.docx Supplementary Document
Focus Group Example_Focus Group Guide.docx Supplementary Document
Supporting Statement B 12.8.23.docx Supporting Statement B
Supporting Statement A 12.8.23.docx Supporting Statement A
HRSA Web Survey Form
Title V Information System User Satisfaction Survey Form and Instruction
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form
Tree Testing of HRSA's Ryan White HIV/AIDS Program website Other-Tree Test Plan
Collection of Qualitative Feedback on Telehealth.HHS.gov Form and Instruction
National Practitioner Data Bank Usability Survey Form and Instruction
Evaluation Survey of Eligible National Practitioner Data Bank Entity Users: Relevance of Information Collected via NPDB Query Forms Form and Instruction
National Marrow Donor Program Donation Experience Survey Form and Instruction
Maternal, Infant, and Early Childhood Home Visiting Site Visit Awardee Feedback Form Form and Instruction
Maternal, Infant, and Early Childhood Home Visiting Program On-Site Compliance Review Awardee Feedback Form Form
2024 Maternal, Infant, and Early Childhood Home Visiting Program All Grantee Meeting Evaluation Surveys Form
Maternal, Infant, and Early Childhood Home Visiting Innovation Technical Assistant Center Satisfaction Surveys Form
Health Center Program Support Customer Service Survey Form and Instruction
HRSA Electronic Handbooks Customer Service Survey Form and Instruction
Early Childhood Systems Technical Assistance and Coordinating Center Customer Satisfaction Surveys Form and Instruction
Division of Independent Review Objective Review Assessment Survey Form and Instruction
Division of Grants Management Operations Customer Service Satisfaction Survey Form

All Historical Document Collections

202401-0915-004 Approved without change	Revision of a currently approved collection	2024-01-10
202401-0915-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2024-01-04
202312-0915-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2023-12-14
202308-0915-005 Approved without change	No material or nonsubstantive change to a currently approved collection	2023-08-17
202103-0915-002 Approved without change	Extension without change of a currently approved collection	2021-03-16
202012-0915-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2020-12-08
201506-0915-001 Approved with change	Extension without change of a currently approved collection	2018-05-15
201502-0915-002 Approved without change	Extension without change of a currently approved collection	2015-03-12
201206-0915-002 Approved with change	Revision of a currently approved collection	2012-06-08
200904-0915-002 Approved without change	Extension without change of a currently approved collection	2009-04-27
200809-0915-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2008-09-03
200709-0915-002 Withdrawn and continue	No material or nonsubstantive change to a currently approved collection	2007-09-23
200707-0915-004 Withdrawn and continue	No material or nonsubstantive change to a currently approved collection	2007-07-30
200603-0915-001 Approved without change	Extension without change of a currently approved collection	2006-03-20
200302-0915-001 Approved without change	Extension without change of a currently approved collection	2003-02-05
200002-0915-004 Approved without change	Extension without change of a currently approved collection	2000-02-24
199702-0915-001 Approved without change	New collection (Request for a new OMB Control Number)	1997-02-03

OMB Details

Building Futures: Supporting Youth Living with HIV, Feedback on Toolkit and Webinars

Federal Enterprise Architecture: Health - Health Care Services

Form 1

BF_Webinar_Survey_4_24_2018.docx

Fillable Fileable

Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.