IHS CHR NET Plenary Evaluation Form

Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: IHS Customer Service Satisfaction and Similar Surveys

OMB: 0917-0036

IC ID: 216457

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Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
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IHS CHR NET Plenary Evaluation Form 17
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0917-0036 IHS CHR NET Plenary Evaluation Form OMB No. 0917-0036, IHS CHR NET Plenary Evaluation Form.doc Yes Yes Fillable Fileable

Health Health Care Services

 

325 0
   
Individuals or Households
 
   0 %

  Requested 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 325 0 0 0 0 325
Annual IC Time Burden (Hours) 27 0 0 0 0 27
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
OMB No. 0917-0036, Mini-Supporting Statement for IHS CHR NET Plenary Evaluation Form OMB No. 0917-0036, Mini-Supporting Statement.docx 05/12/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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