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Federal forms, ICRs, and supporting documents

Information Collection Request

Common Reporting Requirements for Urban Indian Health Program

ICR 199806-0917-001 · OMB 0917-0007 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
6563 Common Reporting Requirements for Urban Indian Health Program Migrated
ICR Details
0917-0007 199806-0917-001
Historical Active 199507-0917-002
HHS/IHS
Common Reporting Requirements for Urban Indian Health Program
Revision of a currently approved collection   No
Regular
Approved without change 08/28/1998
Retrieve Notice of Action (NOA) 06/11/1998
OMB approves this submission in concept but is unable to approve the details of the forms and instructions until IHS responds in writing to the attached OMB concerns (as previously discussed with IHS.) Upon review of IHS' written response, OMB may request explicit amendments to the forms and/or instructions, e.g. in detailed age breakouts, service definitions, etc.
  Inventory as of this Action Requested Previously Approved
02/29/2000 02/29/2000 08/31/1998
261 0 68
413 0 726
0 0 0
The American Indian/Alaska Native (AI/AN) urban health organizations contracting with the Indian Health Service to provide health care services to AI/ANs in urban settings provide the requested information. The information is collected annually and is used to monitor and evaluate contractor performance, prepare budget reports, and allocate resources.
None
None
No
1
IC Title Form No. Form Name
Common Reporting Requirements for Urban Indian Health Program
  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 261 68 0 193 0 0
Annual Time Burden (Hours) 413 726 0 -313 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/11/1998