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Mashpee Wampanoag Indian Health Service Unit Community Health Assessment
Mashpee Wampanoag Indian Health Service Unit Community Health Assessment
OMB: 0917-0039
IC ID: 231678
OMB.report
HHS/IHS
OMB 0917-0039
ICR 201707-0917-001
IC 231678
( )
Documents and Forms
Document Name
Document Type
Form 0917-Mashpee
Mashpee Wampanoag Indian Health Service Unit Community Health Assessment
Form and Instruction
0917-Mashpee Mashpee Wampanoag Indian Health Service Unit Community H
IHS Mashpee CHA_Survey_STC-FINAL VERSION-Changed Questions 5.18.18.pdf
Form and Instruction
Part A Mashpee Wampanoag Indian Health Service Unit Community Health Assessment.docx
Mashpee Wampanoag Indian Health Service Unit Community Health Assessment
IC Document
Part B- Mashpee Wampanoag Indian Health Service Unit Community Health Assessment.docx
Mashpee Wampanoag Indian Health Service Unit Part B
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Mashpee Wampanoag Indian Health Service Unit Community Health Assessment
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
0917-Mashpee
Mashpee Wampanoag Indian Health Service Unit Community Health Assessment
IHS Mashpee CHA_Survey_STC-FINAL VERSION-Changed Questions 5.18.18.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
324
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
324
0
324
0
0
0
Annual IC Time Burden (Hours)
135
0
135
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Mashpee Wampanoag Indian Health Service Unit Community Health Assessment
Part A Mashpee Wampanoag Indian Health Service Unit Community Health Assessment.docx
06/07/2018
Mashpee Wampanoag Indian Health Service Unit Part B
Part B- Mashpee Wampanoag Indian Health Service Unit Community Health Assessment.docx
06/07/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.