OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Indian Health Service (IHS Website Feedback Form

IC 216396 under ICR 202201-0917-001 · OMB 0917-0036.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Indian Health Service (IHS Website Feedback Form 2
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0917-0036 IHS Website Feedback Form OMB 0917-0036-02 IHS Website Feedback Form.pdf http://www.ihs.gov/feedbackform/ Yes Yes Fillable Fileable
Form and Instruction 0917-0036 IHS Website Customer Satisfaction Survey - First Page IHSGovWebsiteFeedbackForm.jpg Yes Yes Fillable Fileable

Health Health Care Services

 

500 0
   
Individuals or Households
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 500 0 0 0 0 500
Annual IC Time Burden (Hours) 125 0 0 0 0 125
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
OMB No. 0917-0036, Mini-Supporting Statement for IHS Website Customer Satisfaction Survey 2014GenericClearanceSubmissionTemplate_IHSGovFeedbackForm.doc 05/05/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.