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⚠️ Notice: This information collection may be referencing outdated material.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 of Federal Employment Final_AddendumtoDeclarationorFederalEmploymentOGCPHD final copy 9.20.18.doc www.ihs.gov/jobs/ Form and Instruction
OMB Form No. 3206-0182 0306[1].pdf Declaration for Federal Employment (OPM OF 306; OMB No. 3206-0182) IC Document
2018-20989.pdf 60 Day FRN IC Document
2018-25819.pdf 30 day FRN IC Document
0917-0028_Supporting_Statement_A__2018.doc Supporting Statement 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 of Federal Employment	Final_AddendumtoDeclarationorFederalEmploymentOGCPHD final copy 9.20.18.doc	https://www.ihs.gov/jobs/	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 FRN	2018-20989.pdf	11/28/2018
30 day FRN	2018-25819.pdf	11/28/2018
Supporting Statement	0917-0028_Supporting_Statement_A__2018.doc	11/28/2018

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