OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Mashpee Wampanoag Indian Health Service Unit Community Health Assessment

ICR 201707-0917-001 · OMB 0917-0039 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0917-Mashpee Mashpee Wampanoag Indian Health Service Unit Community Health Assessment Form and Instruction New Repair queued
Part A-FINAL Mashpee submission.docx Supporting Statement A Uploaded 2018-06-13 Available
Part B- Mashpee Wampanoag Indian Health Service Unit Community Health Assessment.docx Supporting Statement B Uploaded 2018-06-11 Available
IC Document Collections
IC IDCollectionTypeStatusForm
231678 Mashpee Wampanoag Indian Health Service Unit Community Health Assessment Form and Instruction New
ICR Details
0917-0039 201707-0917-001
Active
HHS/IHS
Mashpee Wampanoag Indian Health Service Unit Community Health Assessment
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 06/19/2018
Retrieve Notice of Action (NOA) 08/02/2017
This collection is approved consistent with the understanding that once IHS has a contractor on board, they will submit an amended Part B to OMB that includes the sampling plan, collection protocol, and analysis plan. The change request must be approved by OMB before beginning the study. No additional request for public comment is needed.
  Inventory as of this Action Requested Previously Approved
06/30/2021 36 Months From Approved
324 0 0
135 0 0
0 0 0
The collection of information is used to evaluate the health care needs of the Mashpee Wampanoag Tribal community. As a healthcare organization, the Mashpee Wampanoag Health Service Unit has questions regarding a respondent’s health status, behavior and social practices as well as environmental concerns. These answers will help the organization assess healthcare needs of the community and guide the implementation of programs. The Mashpee Wampanoag Tribal Health Service Unit will be able to assess the community’s needs and plan our programs accordingly to improve the health and well-being of the community.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  82 FR 11361 02/22/2017
82 FR 23260 05/22/2017
No
  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 324 0 0 324 0 0
Annual Time Burden (Hours) 135 0 0 135 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new IC.
$98,081
No
    No
    No
No
No
No
Uncollected
Evonne Bennett-Barnes 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.
08/02/2017