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Tribal Partner Survey
IHS Customer Satisfaction Survey
OMB: 0917-0035
IC ID: 192424
OMB.report
HHS/IHS
OMB 0917-0035
ICR 201004-0917-002
IC 192424
( )
Documents and Forms
Document Name
Document Type
TribalPartnerSurvey10292009.doc
Tribal Partner Survey
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Tribal Partner Survey
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
5 CFR 1320.5
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:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
200
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
200
0
200
0
0
0
Annual IC Time Burden (Hours)
10
0
10
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Tribal Partner Survey
TribalPartnerSurvey10292009.doc
11/06/2009
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
