OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: IHS Customer Service Satisfaction and Similar Surveys

ICR 201804-0917-001 · OMB 0917-0036 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0917-0036 OIT RPMS Training Needs Assessment Survey Form and Instruction New Repair queued
Form 0917-0036 Patient Experience Surveys - White Earth Service Unit Form and Instruction New Repair queued
Form 0917-0036 Diabetes Care Survey Form and Instruction New Repair queued
Form 0917-0036 IHS Chinle Service Unit Customer Experience Survey Form and Instruction New Repair queued
Form 9017-0036 Dental Professionals & Human Papillomavirus (HPV) Prevention Survey Form and Instruction New Available
Form 9017-0036 Tele-Behavioral Health Center of Excellence (TBHCE) Survey Form and Instruction New Repair queued
Form 87 Medication-Assisted Treatment (MAT) Providers & PrEP Providers Survey Form and Instruction New Available
Form 0917-0036-86 Confer Satisfaction Survey Form New Repair queued
Form 9017-0036 IHS Impact Evaluation of Community Health Representative (CHR) Program Web-based Survey Form and Instruction New Available
Form 0917-0036 Evaluation Survey of IHS Mandatory Pain and Opioid Training and Prescriber Habits Form and Instruction Unchanged Available
Form 0917-0036 IHS White Earth Hand Washing Survey Form and Instruction Unchanged Available
Form 0917-0036 Fort Washakie Medical Home Patient Feedback Form and Instruction Unchanged Repair queued
Form 0917-0036-12 Patient Satisfaction Survey, Optometry Dept. White Earth Service Unit Indian Health Service Form and Instruction Unchanged Repair queued
Form 0917-0036-23 IHS Training Needs Survey Form and Instruction Unchanged Repair queued
Form 0917-0036 IHS Chinle Service Unit Customer Experience Survey – Clinical and Community Nutrition Form Unchanged Repair queued
Form 0917-0036 WebTMA Survey Form and Instruction Unchanged Available
Form 0917-0036 Telebehavioral Health Patient Satisfaction Survey Form Unchanged Available
Form 0917-0036 Public Health Nursing Data Mart Survey Form and Instruction Unchanged Available
Form 0917-0036 Patient Experience of Care Survey Pilot Project Form and Instruction Unchanged Available
Form IHS Web Services C IHS Web Services Customer Satisfaction Survey Form Unchanged Available
Form 0917-0036 PT/OT (Therapy Department) - Provision of Care Survey Form and Instruction Removed Repair queued
Form 0917-0036 OMB Form No. 0917-0036, Indian Health Service (IHS) Community Health Representative (CHR) Basic Online Training Evaluation Form and Instruction Removed Repair queued
Form 0917-0036 OMB Form No. 0917-0036: IHS Chinle Service Unit Customer Experience Survey, Division of Public Health. Form and Instruction Unchanged Available
Form 0917-0036 Pediatric Care Unit (PCU) Patient Experience Survey, Chinle Service Unit (CSU) Form and Instruction Unchanged Available
Form 0917-0036 Obstetric Care Unit (OCU) Patient Experience Survey, Chinle Service Unit Form and Instruction Unchanged Repair queued
Form 0917-0036 Special Care Unit (SCU) Patient Experience Survey, Chinle Service Unit Form and Instruction Unchanged Repair queued
Form 0917-0036 Adult Care Unit (ACU) Patient Experience Survey, Chinle Service Unit (CSU) Form and Instruction Unchanged Repair queued
Form 0917-0036 Chinle Service Unit (CSU) Employee Satisfaction Survey. Form and Instruction Unchanged Available
Form 0917-0036 We Care Survey, Fort Peck Service Unit Indian Health Service Form and Instruction Unchanged Repair queued
Form 0917-0036 Clinical Decision Support Usability Assessment Form and Instruction Unchanged Available
Form 0917-0036 Patient Satisfaction Survey, Crow Service Unit Form and Instruction Removed Available
Form 0917-0036 Sugar Shockers Health Campaign Survey, Catawba Service Unit Form and Instruction Removed Repair queued
Form 0917-0036 User satisfaction data collection for the IHS OIT NDW Form and Instruction Unchanged Available
Form 0917-0036 We Care Survey, Northern Cheyenne Form and Instruction Unchanged Repair queued
Form 0917-0036 We Care Survey, Blackfeet Community Hospital. Form and Instruction Unchanged Repair queued
Form 0917-0036 Indian Health Service (IHS) Wind River Service Unit (WRSU) Customer Satisfaction Survey Form and Instruction Removed Available
Form 0917-0036 Catawba Service Unit Patient Satisfaction Survey Form and Instruction Unchanged Repair queued
Form 0917-0036 IHS RPMS Stakeholder Survey – Resource and Patient Management System Program Operational Analysis Needs Assessment Form and Instruction Unchanged Repair queued
Form 0917-0036 We Care Survey, Fort Peck Service Unit Indian Health Service Form and Instruction Unchanged Repair queued
Form 0917-0036 THC Dental Patient Satisfaction Survey Form and Instruction Removed Available
Form 0917-0036 Patient Satisfaction Survey, Tohatchi Form and Instruction Removed Repair queued
Form 0917-0036 Gallup Service Unit Patient Satisfaction Survey Form and Instruction Removed Available
Form 0917-0036 Patient Satisfaction Survey, Alburquerque Service Unit Form and Instruction Unchanged Available
Form 0917-0036 Providers –e-RX Deployment Survey Form and Instruction Removed Available
Form 0917-0036 White Earth Dental Clinic Patient Satisfaction Survey Form and Instruction Unchanged Repair queued
Form 0917-0036 Patient Flow Time Study Form and Instruction Unchanged Available
Form 0917-0036 Patient Satisfaction Survey, at Cheyenne River Health Center (CRHC) Form and Instruction Unchanged Available
Form 0917-0036 EHR Pharmacy Residence Informaticists Survey Form and Instruction Removed Available
Form 0917-0036 eLearning Hands-on Customer Satisfaction Survey Form and Instruction Unchanged Available
Form 0917-0036 Computer Based Post Class Survey Form and Instruction Unchanged Available
Form 0917-0036 IHS Website ICD-10 Stakeholder Readiness Survey – ICD-10 Project Needs Assessment Form and Instruction Removed Repair queued
Form 0917-0036 IHS Patient Experience Survey Form and Instruction Unchanged Available
Form 0917-0036 IHS RPMS Annual Training Needs Assessment Survey Form and Instruction Removed Available
Form 0917-0036 VPN User Survey Form and Instruction Removed Available
Form 0917-0036 Portland Area Division of Environment Health Services: Customer Service Assessment. Form and Instruction Removed Repair queued
Form 0917-0036 IHS OEHE Customer Satisfaction Forms Form and Instruction Removed Available
Form 0917-0036 IHS Pharmacy Automation 2015 Survey Form and Instruction Unchanged Available
Form 0917-0036 Indian Health Service (IHS) Clinical Rounds Qualitative Feedback Form and Instruction Unchanged Repair queued
Form 0917-0036 IHS CHR NET Plenary Evaluation Form Form and Instruction Unchanged Repair queued
Form 0917-0036 Indian Health Service (IHS) Community Health Representatives (CHR) Diabetes Online Training Evaluation Form and Instruction Unchanged Repair queued
Form 0917-0036 IHS Community Health Representative Basic Training & Refresher Course Training form Form and Instruction Removed Available
Form 0917-0036 OIT Customer Satisfaction Survey – Problem Ticket Form and Instruction Unchanged Available
Form 0917-0036 OIT Customer Satisfaction Survey-Service Ticket Form and Instruction Removed Available
Form 0917-0036 Physician/Dentist Customer Service Questionnaire Form and Instruction Unchanged Repair queued
Form 0917-0036 Patient Assessment –Clinton Service Unit - IMPRESS Form and Instruction Unchanged Available
Form 0917-0036 Employee Assessment- Clinton Service Unit - IMPRESS Form and Instruction Unchanged Available
Form 0917-0036 Indian Health Service (IHS) FY_ Satellite Classroom Post Class Survey Form and Instruction Unchanged Available
Form 0917-0036 Indian Health Service (IHS) FY_ eLearning Post Class Survey Form and Instruction Unchanged Available
Form 0917-0036 Indian Health Service (IHS) FY_ Classroom Post Class Survey Form and Instruction Unchanged Available
Form 0917-0036 IHS Website Customer Satisfaction Survey – EHR Survey Monkey – VIRTUAL Form and Instruction Removed Available
Form 0917-0036 IHS Website Customer Satisfaction Survey – EHR Survey Monkey – Classroom Form Form and Instruction Removed Available
Form 0917-0036 Indian Health Service (IHS Website Feedback Form Form and Instruction Unchanged Available
Supporting Statement A for OMB No. 0917-0036, IHS Fast Track for Generic Clearance 2018.docx Supporting Statement A Uploaded 2018-07-11 Repair queued
Justification for Burden Increase.docx Justification for No Material/Nonsubstantive Change Uploaded 2013-01-18 Available
IC Document Collections
IC IDCollectionTypeStatusForm
242056 OIT RPMS Training Needs Assessment Survey Form and Instruction New
237875 Patient Experience Surveys - White Earth Service Unit Form and Instruction New
237873 Diabetes Care Survey Form and Instruction New
236418 IHS Chinle Service Unit Customer Experience Survey Form and Instruction New
236413 Dental Professionals & Human Papillomavirus (HPV) Prevention Survey Form and Instruction New
236408 Tele-Behavioral Health Center of Excellence (TBHCE) Survey Form and Instruction New
235443 Medication-Assisted Treatment (MAT) Providers & PrEP Providers Survey Form and Instruction New
235441 Confer Satisfaction Survey Form New
235243 IHS Impact Evaluation of Community Health Representative (CHR) Program Web-based Survey Form and Instruction New
230847 Evaluation Survey of IHS Mandatory Pain and Opioid Training and Prescriber Habits Form and Instruction Unchanged
230260 IHS White Earth Hand Washing Survey Form and Instruction Unchanged
229103 Fort Washakie Medical Home Patient Feedback Form and Instruction Unchanged
228427 Patient Satisfaction Survey, Optometry Dept. White Earth Service Unit Indian Health Service Form and Instruction Unchanged
227895 Innovative Session Partnership Conference Other-Discussion Questions Unchanged
227765 IHS Training Needs Survey Form and Instruction Unchanged
226315 IHS Chinle Service Unit Customer Experience Survey – Clinical and Community Nutrition Form Unchanged
226049 WebTMA Survey Form and Instruction Unchanged
225049 Telebehavioral Health Patient Satisfaction Survey Form Unchanged
225048 Public Health Nursing Data Mart Survey Form and Instruction Unchanged
224877 Patient Experience of Care Survey Pilot Project Form and Instruction Unchanged
223611 IHS Web Services Customer Satisfaction Survey Form Unchanged
221047 PT/OT (Therapy Department) - Provision of Care Survey Form and Instruction Removed
218957 OMB Form No. 0917-0036, Indian Health Service (IHS) Community Health Representative (CHR) Basic Online Training Evaluation Form and Instruction Removed
218239 OMB Form No. 0917-0036: IHS Chinle Service Unit Customer Experience Survey, Division of Public Health. Form and Instruction Unchanged
217933 Pediatric Care Unit (PCU) Patient Experience Survey, Chinle Service Unit (CSU) Form and Instruction Unchanged
217932 Obstetric Care Unit (OCU) Patient Experience Survey, Chinle Service Unit Form and Instruction Unchanged
217748 Special Care Unit (SCU) Patient Experience Survey, Chinle Service Unit Form and Instruction Unchanged
217747 Adult Care Unit (ACU) Patient Experience Survey, Chinle Service Unit (CSU) Form and Instruction Unchanged
217690 Chinle Service Unit (CSU) Employee Satisfaction Survey. Form and Instruction Unchanged
217673 We Care Survey, Fort Peck Service Unit Indian Health Service Form and Instruction Unchanged
216572 Clinical Decision Support Usability Assessment Form and Instruction Unchanged
216564 Patient Satisfaction Survey, Crow Service Unit Form and Instruction Removed
216563 Sugar Shockers Health Campaign Survey, Catawba Service Unit Form and Instruction Removed
216545 User satisfaction data collection for the IHS OIT NDW Form and Instruction Unchanged
216544 We Care Survey, Northern Cheyenne Form and Instruction Unchanged
216538 We Care Survey, Blackfeet Community Hospital. Form and Instruction Unchanged
216534 Indian Health Service (IHS) Wind River Service Unit (WRSU) Customer Satisfaction Survey Form and Instruction Removed
216532 Catawba Service Unit Patient Satisfaction Survey Form and Instruction Unchanged
216531 IHS RPMS Stakeholder Survey – Resource and Patient Management System Program Operational Analysis Needs Assessment Form and Instruction Unchanged
216529 We Care Survey, Fort Peck Service Unit Indian Health Service Form and Instruction Unchanged
216517 THC Dental Patient Satisfaction Survey Form and Instruction Removed
216516 Patient Satisfaction Survey, Tohatchi Form and Instruction Removed
216515 Gallup Service Unit Patient Satisfaction Survey Form and Instruction Removed
216514 Patient Satisfaction Survey, Alburquerque Service Unit Form and Instruction Unchanged
216513 Providers –e-RX Deployment Survey Form and Instruction Removed
216512 White Earth Dental Clinic Patient Satisfaction Survey Form and Instruction Unchanged
216510 Patient Flow Time Study Form and Instruction Unchanged
216509 Patient Satisfaction Survey, at Cheyenne River Health Center (CRHC) Form and Instruction Unchanged
216501 EHR Pharmacy Residence Informaticists Survey Form and Instruction Removed
216500 eLearning Hands-on Customer Satisfaction Survey Form and Instruction Unchanged
216499 Computer Based Post Class Survey Form and Instruction Unchanged
216498 IHS Website ICD-10 Stakeholder Readiness Survey – ICD-10 Project Needs Assessment Form and Instruction Removed
216493 IHS Patient Experience Survey Form and Instruction Unchanged
216478 IHS RPMS Annual Training Needs Assessment Survey Form and Instruction Removed
216474 VPN User Survey Form and Instruction Removed
216470 Portland Area Division of Environment Health Services: Customer Service Assessment. Form and Instruction Removed
216465 IHS OEHE Customer Satisfaction Forms Form and Instruction Removed
216464 IHS Pharmacy Automation 2015 Survey Form and Instruction Unchanged
216462 Indian Health Service (IHS) Clinical Rounds Qualitative Feedback Form and Instruction Unchanged
216457 IHS CHR NET Plenary Evaluation Form Form and Instruction Unchanged
216453 Indian Health Service (IHS) Community Health Representatives (CHR) Diabetes Online Training Evaluation Form and Instruction Unchanged
216452 IHS Community Health Representative Basic Training & Refresher Course Training form Form and Instruction Removed
216429 OIT Customer Satisfaction Survey – Problem Ticket Form and Instruction Unchanged
216427 OIT Customer Satisfaction Survey-Service Ticket Form and Instruction Removed
216426 Physician/Dentist Customer Service Questionnaire Form and Instruction Unchanged
216424 Patient Assessment –Clinton Service Unit - IMPRESS Form and Instruction Unchanged
216421 Employee Assessment- Clinton Service Unit - IMPRESS Form and Instruction Unchanged
216417 Indian Health Service (IHS) FY_ Satellite Classroom Post Class Survey Form and Instruction Unchanged
216415 Indian Health Service (IHS) FY_ eLearning Post Class Survey Form and Instruction Unchanged
216412 Indian Health Service (IHS) FY_ Classroom Post Class Survey Form and Instruction Unchanged
216402 IHS Website Customer Satisfaction Survey – EHR Survey Monkey – VIRTUAL Form and Instruction Removed
216397 IHS Website Customer Satisfaction Survey – EHR Survey Monkey – Classroom Form Form and Instruction Removed
216396 Indian Health Service (IHS Website Feedback Form Form and Instruction Unchanged
ICR Details
0917-0036 201804-0917-001
Active 201504-0917-007
HHS/IHS 1
Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: IHS Customer Service Satisfaction and Similar Surveys
Extension without change of a currently approved collection   No
Regular
Approved without change 01/30/2019
Retrieve Notice of Action (NOA) 07/12/2018
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
01/31/2022 36 Months From Approved 02/28/2019
105,000 0 105,000
17,500 0 17,500
0 0 0
This fast track generic collection of information 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, efficient, and satisfying experience with the Agency's programs.
EO: EO 12862 Name/Subject of EO: SETTING CUSTOMER SERVICE STANDARDS
   US Code: 44 USC 3501 Name of Law: Paperwork Reduction Act
  
None
Not associated with rulemaking
  82 FR 45034 09/27/2017
82 FR 56833 11/30/2017
Yes
54
IC Title Form No. Form Name
White Earth Dental Clinic Patient Satisfaction Survey 0917-0036 White Earth Dental Clinic Patient Satisfaction Survey
Physician/Dentist Customer Service Questionnaire 0917-0036 Physician/Dentist Customer Service Questionnaire
Special Care Unit (SCU) Patient Experience Survey, Chinle Service Unit 0917-0036 Special Care Unit (SCU) Patient Experience Survey
Patient Experience of Care Survey Pilot Project 0917-0036 Patient Experience of Care Survey
Patient Satisfaction Survey, Optometry Dept. White Earth Service Unit Indian Health Service 0917-0036-12 Patient Satisfaction Survey for the White Earth Optometry Dept.
Evaluation Survey of IHS Mandatory Pain and Opioid Training and Prescriber Habits 0917-0036 Evaluation Survey
Indian Health Service (IHS) FY_ eLearning Post Class Survey 0917-0036 Indian Health Service (IHS) FY_ eLearning Post Class Survey
Catawba Service Unit Patient Satisfaction Survey 0917-0036 Catawba Service Unit Patient Satisfaction Survey
We Care Survey, Northern Cheyenne 0917-0036 We Care Patient Satisfaction Survey for Northern Cheyenne
User satisfaction data collection for the IHS OIT NDW 0917-0036 Indian Health Service, Office of Information Technology, National Patient Reporting System National Data Warehouse Data Collection Survey
Patient Satisfaction Survey, Tohatchi 0917-0036 Patient Satisfaction Survey, Tohatchi
Telebehavioral Health Patient Satisfaction Survey 0917-0036 Telebehavioral Health Patient Satisfaction Survey
Portland Area Division of Environment Health Services: Customer Service Assessment. 0917-0036 Portland Area Division of Environment Health Services: Customer Service Assessment.
IHS RPMS Annual Training Needs Assessment Survey 0917-0036 IHS RPMS Annual Training Needs Assessment Survey
OMB Form No. 0917-0036, Indian Health Service (IHS) Community Health Representative (CHR) Basic Online Training Evaluation 0917-0036 IHS CHR Basic Online Training Evaluation
eLearning Hands-on Customer Satisfaction Survey 0917-0036 eLearning Hands-on Customer Satisfaction survey
Medication-Assisted Treatment (MAT) Providers & PrEP Providers Survey 87, 87-1 MAT Provider Survey ,   PrEP Questionnaire
Diabetes Care Survey 0917-0036 Diabetes Care Survey
Dental Professionals & Human Papillomavirus (HPV) Prevention Survey 9017-0036 HPV Survey
IHS Chinle Service Unit Customer Experience Survey 0917-0036, 0917-0036 Community Nutrition ,   Gardening Survey
IHS Pharmacy Automation 2015 Survey 0917-0036 IHS Pharmacy Automation 2015 Survey
Indian Health Service (IHS) FY_ Classroom Post Class Survey 0917-0036 Indian Health Service (IHS) FY_ Classroom Post Class Survey
Innovative Session Partnership Conference
IHS White Earth Hand Washing Survey 0917-0036 Hand Washing Survey
Patient Satisfaction Survey, Crow Service Unit 0917-0036 Patient Satisfaction Survey, Crow Service Unit
Pediatric Care Unit (PCU) Patient Experience Survey, Chinle Service Unit (CSU) 0917-0036 Pediatric Care Unit (PCU) Patient Experience Survey, Chinle Service Unit CSU)
Patient Experience Surveys - White Earth Service Unit 0917-0036, 0917-0036, 0917-0036, 0917-0036, 0917-0036 Dental Survey ,   Lab Dept Survey ,   Optometry Survey ,   Radiology Dept Survey ,   Therapist Survey
Indian Health Service (IHS) Community Health Representatives (CHR) Diabetes Online Training Evaluation 0917-0036 Indian Health Service (IHS) Community Health Representatives (CHR) Diabetes Online Training Evaluation
IHS RPMS Stakeholder Survey – Resource and Patient Management System Program Operational Analysis Needs Assessment 0917-0036 Indian Health Service (IHS) RPMS Stakeholder Survey – Resource and Patient Management System Program Operational Analysis Needs Assessment
Indian Health Service (IHS) FY_ Satellite Classroom Post Class Survey 0917-0036, 0917-0036 Indian Health Service (IHS) FY_ Satellite Classroom Post Class Survey ,   FY___Satellite Classroom with Areas Post Class Survey
OMB Form No. 0917-0036: IHS Chinle Service Unit Customer Experience Survey, Division of Public Health. 0917-0036, 0917-0036, 0917-0036, 0917-0036, 0917-0036, 0917-0036, 0917-0036, 0917-0036 Wellness Center Survey ,   Adolescent School Health ,   Community Nutrition Survey ,   Diabetes Survey ,   Health Promotion Survey ,   Native Medicine Survey ,   Public Health Nursing - for Patient Care Giver - Survey ,   Public Health Nursing - for Patient
IHS Chinle Service Unit Customer Experience Survey – Clinical and Community Nutrition 0917-0036, 0917-0036 Community Nutrition Gardening Survey ,   RDN Services Survey
IHS Website ICD-10 Stakeholder Readiness Survey – ICD-10 Project Needs Assessment 0917-0036 IHS Website ICD-10 Stakeholder Readiness Survey – ICD-10 Project Needs Assessment
Patient Assessment –Clinton Service Unit - IMPRESS 0917-0036 Patient Assessment –Clinton Service Unit - IMPRESS
THC Dental Patient Satisfaction Survey 0917-0036 THC Dental Patient Satisfaction Survey
Computer Based Post Class Survey 0917-0036 Computer Based Training (CBT)Post Class Survey
Providers –e-RX Deployment Survey 0917-0036 Providers - e-RX Deployment Survey
We Care Survey, Fort Peck Service Unit Indian Health Service 0917-0036 We Care Survey, Fort Peck Service Unit Indian Health Service
EHR Pharmacy Residence Informaticists Survey 0917-0036 EHR Pharmacy Residence Informaticists Survey
Patient Flow Time Study 0917-0036 Patient Flow Time Study
Confer Satisfaction Survey 0917-0036-86 Confer Satisfaction Survey
Indian Health Service (IHS) Wind River Service Unit (WRSU) Customer Satisfaction Survey 0917-0036, 0917-0036, 0917-0036 Coordinated Care Survey ,   Patient Registration Suvey ,   Patient Wellness Survey
OIT Customer Satisfaction Survey – Problem Ticket 0917-0036, 0917-0036 OIT Customer Satisfaction Survey – Problem Ticket ,   OIT Customer Satisfaction Survey – Problem Ticket (screen shot)
Sugar Shockers Health Campaign Survey, Catawba Service Unit 0917-0036 Sugar Shockers Health Campaign Survey, Catawba Service Unit
Clinical Decision Support Usability Assessment 0917-0036 Clinical Decision Support Usability Assessment
Adult Care Unit (ACU) Patient Experience Survey, Chinle Service Unit (CSU) 0917-0036 Adult Care Unit (ACU) Patient Experience Survey, Chinle Service Unit
Public Health Nursing Data Mart Survey 0917-0036 Public Health Nursing (PHN) Data Mart Survey Questions
WebTMA Survey 0917-0036 WebTMA Survey
IHS Website Customer Satisfaction Survey – EHR Survey Monkey – Classroom Form 0917-0036 IHS Website Customer Satisfaction Survey – EHR Survey Monkey – Classroom Form
We Care Survey, Blackfeet Community Hospital. 0917-0036 We Care Survey, Blackfeet Community Hospital.
OIT Customer Satisfaction Survey-Service Ticket 0917-0036, 0917-0036 OIT Customer Satisfaction Survey-Service Ticket ,   OIT Customer Satisfaction Survey-Service Ticket (screen shot)
VPN User Survey 0917-0036 VPN User Survey
Patient Satisfaction Survey, at Cheyenne River Health Center (CRHC) 0917-0036 Patient Satisfaction Survey, at Cheyenne River Health Center (CRHC)
IHS Community Health Representative Basic Training & Refresher Course Training form 0917-0036 IHS Community Health Representative Basic Training & Refresher Course Training form
Patient Satisfaction Survey, Alburquerque Service Unit 0917-0036 Patient Satisfaction Survey, Alburquerque Service Unit
Indian Health Service (IHS) Clinical Rounds Qualitative Feedback 0917-0036 Indian Health Service (IHS) Clinical Rounds Qualitative Feedback
Obstetric Care Unit (OCU) Patient Experience Survey, Chinle Service Unit 0917-0036 Obstetrical Care Unit (OCU) Patient Experience Suvey, Chinle Service Unit (CSU)
We Care Survey, Fort Peck Service Unit Indian Health Service 0917-0036 We Care Survey, Fort Peck Service Unit, Indian Health Service
IHS Training Needs Survey 0917-0036-23 Training Needs Survey
Fort Washakie Medical Home Patient Feedback 0917-0036 Fort Washakie Medical Home Patient Feedback
PT/OT (Therapy Department) - Provision of Care Survey 0917-0036 PT/OT (Therapy Department) - Provision of Care Survey
IHS OEHE Customer Satisfaction Forms 0917-0036, 0917-0036, 0917-0036, 0917-0036 Annual Operator O & M Survey ,   Post-Construction O & M Survey ,   Tribal Homeowner Survey ,   Tribal Partner Survey
Indian Health Service (IHS Website Feedback Form 0917-0036, 0917-0036 IHS Website Feedback Form ,   IHS Website Customer Satisfaction Survey - First Page
Gallup Service Unit Patient Satisfaction Survey 0917-0036 Gallup Service Unit Patient Satisfaction Survey
IHS Impact Evaluation of Community Health Representative (CHR) Program Web-based Survey 9017-0036 IHS CHR Survey
Tele-Behavioral Health Center of Excellence (TBHCE) Survey 9017-0036 LHP Behaviorial Health Training Needs Survey
OIT RPMS Training Needs Assessment Survey 0917-0036 FY21 OIT RPMS Training Needs Assessment Survey
IHS CHR NET Plenary Evaluation Form 0917-0036 IHS CHR NET Plenary Evaluation Form
Chinle Service Unit (CSU) Employee Satisfaction Survey. 0917-0036 CSU Employee Survey 2015
IHS Web Services Customer Satisfaction Survey IHS Web Services Customer Feedback IHS Web Services Customer Feedback
Employee Assessment- Clinton Service Unit - IMPRESS 0917-0036 Employee Assessment- Clinton Service Unit - IMPRESS
IHS Patient Experience Survey 0917-0036 IHS Patient Experience Survey
IHS Website Customer Satisfaction Survey – EHR Survey Monkey – VIRTUAL 0917-0036 IHS Website Customer Satisfaction Survey – EHR Survey Monkey – VIRTUAL
  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 105,000 105,000 0 0 0 0
Annual Time Burden (Hours) 17,500 17,500 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$25,000
No
    Yes
    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.
07/12/2018