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Tribal Area Health Boards
Healthy People User Study
OMB: 0990-0437
IC ID: 217010
OMB.report
HHS/HHSDM
OMB 0990-0437
ICR 201503-0990-005
IC 217010
( )
Documents and Forms
Document Name
Document Type
0990-Attachment 1_Main Survey Instrument_revised_6.8.15.docx
Other-survey
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Tribal Area Health Boards
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
Other-survey
0990-Attachment 1_Main Survey Instrument_revised_6.8.15.docx
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:
11
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
11
0
11
0
0
0
Annual IC Time Burden (Hours)
3
0
3
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
