Reappointment Application

Indian Health Service Medical Staff Credentials Application

Documents and Forms

Document Name Document Type
Form 0917-0009 Reappointment Application Form and Instruction
0917-0009 IHS MEDICAL STAFF - REAPPOINTMENT APPLICATION Final - Reappointment Application OMB No 0917-0009 - 2020 - JW.pdf Form and Instruction
0917-0009 IHS MEDICAL STAFF - REAPPOINTMENT APPLICATION Final - Reappointment Application OMB No 0917-0009 - 2020 - JW.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Reappointment Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Mandatory

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	0917-0009	IHS MEDICAL STAFF - REAPPOINTMENT APPLICATION	Final - Reappointment Application OMB No 0917-0009 - 2020 - JW.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-1,500	1,500
Annual IC Time Burden (Hours)	-500	500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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