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Obstetric Care Unit (OCU) Patient Experience Survey, Chinle Service Unit
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: 217932
OMB.report
HHS/IHS
OMB 0917-0036
ICR 202201-0917-001
IC 217932
( )
Documents and Forms
Document Name
Document Type
Form 0917-0036
Obstetric Care Unit (OCU) Patient Experience Survey, Chinle Service Unit
Form and Instruction
0917-0036 Obstetrical Care Unit (OCU) Patient Experience Suvey, Ch
0917-0036, Obstetrical Care Unit (OCU) Patient Experience Survey, Chinle Service Unit.pdf
Form and Instruction
0917-0036 Obstetrical Care Unit (OCU) Patient Experience Suvey, Ch
0917-0036, Obstetrical Care Unit (OCU) Patient Experience Survey, Chinle Service Unit.pdf
Form and Instruction
0917-0036, Mini-Supporting Statement for Obstetrical Care Unit (OCU) Patient Experience Survey, Chinle Service Unit (CSU).doc
0917-0036, Mini-Supporting Statement for Obstetrical Care Unit (OCU) Patient Experience Survey, Chinle Service Unit (CSU)
IC Document
0917-0036, Mini-Supporting Statement for Obstetrical Care Unit (OCU) Patient Experience Survey, Chinle Service Unit (CSU).doc
0917-0036, Mini-Supporting Statement for Obstetrical Care Unit (OCU) Patient Experience Survey, Chinle Service Unit (CSU)
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Obstetric Care Unit (OCU) Patient Experience Survey, Chinle Service Unit
Agency IC Tracking Number:
55
IC Status:
Unchanged
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
Form and Instruction
0917-0036
Obstetrical Care Unit (OCU) Patient Experience Suvey, Chinle Service Unit (CSU)
0917-0036, Obstetrical Care Unit (OCU) Patient Experience Survey, Chinle Service Unit.pdf
Yes
No
Printable Only
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:
480
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
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
480
0
0
0
0
480
Annual IC Time Burden (Hours)
48
0
0
0
0
48
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
0917-0036, Mini-Supporting Statement for Obstetrical Care Unit (OCU) Patient Experience Survey, Chinle Service Unit (CSU)
0917-0036, Mini-Supporting Statement for Obstetrical Care Unit (OCU) Patient Experience Survey, Chinle Service Unit (CSU).doc
08/19/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.