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Ihs Community Health Representative Activity Reporting Sample
IHS COMMUNITY HEALTH REPRESENTATIVE ACTIVITY REPORTING SAMPLE
OMB: 0917-0010
IC ID: 110457
OMB.report
HHS/IHS
OMB 0917-0010
ICR 198912-0917-001
IC 110457
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0010 can be found here:
1997-08-29 - Reinstatement without change of a previously approved collection
1993-12-17 - Reinstatement with change of a previously approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
IHS COMMUNITY HEALTH REPRESENTATIVE ACTIVITY REPORTING SAMPLE
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Migrated
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,411
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
5,644
0
0
0
0
5,644
Annual IC Time Burden (Hours)
8,466
0
0
0
0
8,466
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.