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Indian Health Service, Hospital, Dental, And Other Contract Health Service Reports
INDIAN HEALTH SERVICE, HOSPITAL, DENTAL, AND OTHER CONTRACT HEALTH SERVICE REPORTS
OMB: 0917-0002
IC ID: 110438
OMB.report
HHS/IHS
OMB 0917-0002
ICR 199406-0917-002
IC 110438
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0002 can be found here:
2013-02-08 - Revision of a currently approved collection
2010-01-25 - Extension without change of a currently 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:
INDIAN HEALTH SERVICE, HOSPITAL, DENTAL, AND OTHER CONTRACT HEALTH SERVICE REPORTS
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
Form
IHS 43
No
No
Form
IHS 57
No
No
Form
IHS 64
No
No
Federal Enterprise Architecture Business Reference Module
Line of Business:
Subfunction:
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
8,809
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
344,136
0
344,136
0
0
0
Annual IC Time Burden (Hours)
60,316
0
60,316
0
0
0
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.