IHS Background Investigation of Individuals in Positions Involving Regular Contact with or Control Over Indian Children

IHS Background Investigations of Individuals in Positions Involving Regular Contact with or Control Over Indian Children

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0028 can be found here:

Documents and Forms

Document Name Document Type
Form 0917-0028 IHS Background Investigation of Individuals in Positions Involving Regular Contact with or Control Over Indian Children Form and Instruction
0917-0028 Final Addendum to Declaration for Federal Employment (OF Final_Addendum to Declaration for Federal Employment (OF 306) FORM1 OMS TSS REV 08182015 (1).doc www.ihs.gov/Jobs/index.cfm?module=support Form and Instruction
OMB Form No. 3206-0182 0306[1].pdf Declaration for Federal Employment (OPM OF 306; OMB No. 3206-0182) IC Document
FINAL Draft 0917-0028 FR 60 Day Notice rg 6-4-15.docx 60 Day Federal Register Notice for 0917-0028, Addendum to Declaration for Federal Employment, Child Care and Indian Child Care W IC Document
FINAL 0917-0028 FR 30 Day Notice 8-05-2015 with dra edit 08-06-15 - accepted by T.Clay.docx 30 Day Federal Register Notice for OMB No. 0917-0028, Addendum to Declaration for Federal Employment, Child Care and Indian Chil IC Document
FINAL OMB No. 0917-0028 Supporting Statement, 9-24-2015.doc OMB No. 0917-0028, Supporting Statement for IHS Background Investigation of Individuals in Positions Involving Regular Contact w IC Document

Information Collection (IC) Details

IC Title:	IHS Background Investigation of Individuals in Positions Involving Regular Contact with or Control Over Indian Children	Agency IC Tracking Number:	0917-0028

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 136.401-418

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0917-0028	Final Addendum to Declaration for Federal Employment (OF 360) Form, IHS Child Care Positions	Final_Addendum to Declaration for Federal Employment (OF 306) FORM1 OMS TSS REV 08182015 (1).doc	http://www.ihs.gov/Jobs/index.cfm?module=support	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	600	600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Declaration for Federal Employment (OPM OF 306; OMB No. 3206-0182)	OMB Form No. 3206-0182 0306[1].pdf	06/11/2012
60 Day Federal Register Notice for 0917-0028, Addendum to Declaration for Federal Employment, Child Care and Indian Child Care Worker Positions	FINAL Draft 0917-0028 FR 60 Day Notice rg 6-4-15.docx	09/11/2015
30 Day Federal Register Notice for OMB No. 0917-0028, Addendum to Declaration for Federal Employment, Child Care and Indian Child Care Worker Positions	FINAL 0917-0028 FR 30 Day Notice 8-05-2015 with dra edit 08-06-15 - accepted by T.Clay.docx	09/11/2015
OMB No. 0917-0028, Supporting Statement for IHS Background Investigation of Individuals in Positions Involving Regular Contact with or Control Over Indian Children	FINAL OMB No. 0917-0028 Supporting Statement, 9-24-2015.doc	09/24/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.