OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

ICR 201205-0917-002 · OMB 0917-0036 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0917-0036-15 IHS Community Health Representative Basic Training & Refresher Training Form and Instruction New Repair queued
Form 0917-0036-14 OIT Customer Satisfaction Survey - Problem Ticket Form and Instruction New Repair queued
Form 0917-0036-13 OIT Customer Satisfaction Survey - Service Ticket Form and Instruction New Available
Form 0917-0036-12 Physician/Dentist Customer Service Questionairre Form and Instruction New Repair queued
Form 0917-0036-11 Patient Assessment, Clinton Service Unit, IMPRESS Form and Instruction New Repair queued
Form 0917-0036-10 Employee Assessment, Clinton Service Unit, IMPRESS Form and Instruction New Repair queued
Form 0917-0036-07 Satellite Classroom Post Class Survey Form and Instruction New Repair queued
Form 0917-0036-09 iCare Nuts and Bolts Post Class Survey Form and Instruction New Repair queued
Form 0917-0036-08 iCare - CMET Post Course Survey Form and Instruction New Repair queued
Form 0917-0036-06 eLearning Post Class Survey Form and Instruction New Repair queued
Form 0917-0036-05 Classroom Post Class Survey Form and Instruction New Available
Form 0917-0036-04 Website Customer Service Satisfaction Survey - EHR Form New Repair queued
Form 0917-0036-002 Website Customer Service Satisfaction Survey Form and Instruction New Available
Form 0917-0036-03 IHS Website Customer Service Satisfaction Survey - EHR Survey Form and Instruction New Repair queued
Form 0917-0036-01 Indian Health Service Website Customer Service Satisfaction Survey Form and Instruction New Available
Generic_Clearance_Submission_Template.docx Supplementary Document Uploaded 2012-05-18 Repair queued
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Part B - IHS FINAL 5-17-12.doc Supporting Statement B Uploaded 2012-05-17 Available
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Part A - IHS FINAL 5-17-12.docx Supporting Statement A Uploaded 2012-05-17 Available
IC Document Collections
IC IDCollectionTypeStatusForm
205084 IHS Community Health Representative Basic Training & Refresher Training Form and Instruction New
204846 OIT Customer Satisfaction Survey - Problem Ticket Form and Instruction New
204735 OIT Customer Satisfaction Survey - Service Ticket Form and Instruction New
204462 Physician/Dentist Customer Service Questionairre Form and Instruction New
204388 Patient Assessment, Clinton Service Unit, IMPRESS Form and Instruction New
204346 Employee Assessment, Clinton Service Unit, IMPRESS Form and Instruction New
203947 Satellite Classroom Post Class Survey Form and Instruction New
203845 iCare Nuts and Bolts Post Class Survey Form and Instruction New
203753 iCare - CMET Post Course Survey Form and Instruction New
203562 eLearning Post Class Survey Form and Instruction New
203260 Classroom Post Class Survey Form and Instruction New
203096 Website Customer Service Satisfaction Survey - EHR Form New
203035 Website Customer Service Satisfaction Survey Form and Instruction New
202843 IHS Website Customer Service Satisfaction Survey - EHR Survey Form and Instruction New
202645 Indian Health Service Website Customer Service Satisfaction Survey Form and Instruction New
ICR Details
0917-0036 201205-0917-002
Historical Active 201201-0917-001
HHS/IHS
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 05/25/2012
Retrieve Notice of Action (NOA) 05/18/2012
OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.
  Inventory as of this Action Requested Previously Approved
05/31/2015 36 Months From Approved
3,030 0 0
1,030 0 0
0 0 0
This fast track generic collection of infomration is neccesssary to enable IHS to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficeint, and satisfying experience with the Agency's programs.
US Code: 44 USC 3501 Name of Law: Paperwork Reduction Act
   EO: EO 12682 Name/Subject of EO: "Setting Customer Service Standards"
  
None
Not associated with rulemaking
  75 FR 80542 12/22/2010
77 FR 1607 01/10/2012
No
15
IC Title Form No. Form Name
OIT Customer Satisfaction Survey - Problem Ticket 0917-0036-14 OIT Customer Satisfaction Survey - Problem Ticket, OMB No. 0917-0036-14
IHS Community Health Representative Basic Training & Refresher Training 0917-0036-15 OMB Form No., 0917-0036-15, IHS community Health Representative (CHR) Basic and Refresher Training
OIT Customer Satisfaction Survey - Service Ticket 0917-0036-13 OIT Customer Satisfaction Survey-Service Ticket, OMB Form No. 0917-0036-13
Employee Assessment, Clinton Service Unit, IMPRESS 0917-0036-10 0917-0036-10 Employee Assessment
Satellite Classroom Post Class Survey 0917-0036-07 OMB Form No. 0917-0036-07 FY_Satellite Classroom Post Class Survey
Physician/Dentist Customer Service Questionairre 0917-0036-12 OMB No. 0917-0036-12, Physician & Dental Customer Service Questionnaire
IHS Website Customer Service Satisfaction Survey - EHR Survey 0917-0036-03 Indian Health Service (IHS) Website Customer Service Satisfaction Survey - EHR Survey Monkey - CLASS
Website Customer Service Satisfaction Survey - EHR 0917-0036-04 IHS Customer Satisfaction Survey; EHR Survey Monkey - VIRTUAL
iCare - CMET Post Course Survey 0917-0036-08 OMB Form No. 0917-0036-08, iCare-CMET Post Course Survey
Website Customer Service Satisfaction Survey 0917-0036-002 Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: Indian Health Service (IHS) Website Customer Service Satisfaction Survey
eLearning Post Class Survey 0917-0036-06 OMB Form No. 0917-0036-06, FY_ e Learning Post Class Survey
Patient Assessment, Clinton Service Unit, IMPRESS 0917-0036-11 OMB No. 0917-0036-11, Patient Assessment
Indian Health Service Website Customer Service Satisfaction Survey 0917-0036-01 IHS Website Customer Satisfaction Survey Questions
iCare Nuts and Bolts Post Class Survey 0917-0036-09 OMB Form No. 0917-0036-09, iCare Nuts and Bolts Post Class Survey
Classroom Post Class Survey 0917-0036-05 OMB Form No. 0917-05, FY_ Classroom Post Class Survey
  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 3,030 0 0 3,030 0 0
Annual Time Burden (Hours) 1,030 0 0 1,030 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new collection - so there is an increase in burden.
$15,000
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Tamara Clay 301 443-4750 [email protected]
  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.
05/18/2012