0917-0036 IHS Website Feedback Form

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The Federal Health Program for American Indians and Alaska Natives
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1. How often do you visit this website?

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2. Based on today’s visit, how would you rate your website experience overall?
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3. Which of the following best describes the main purpose of your visit?
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6. How do you prefer to find things (navigate) on the site?
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7. Which of the following best describes you?
Health professional

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12. I am usually on the Internet, at work, home or school, not including email Select:
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15. What one thing on this website would you most like to change or fix? (Please do not include personally identifiable information here).

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According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection
is 0917-0036. The time required to complete this information collection is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and
complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services,
OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

Indian Health Service (HQ) - The Reyes Building, 801 Thompson Avenue, Rockville MD, 20852

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