WebTMA Survey

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

Documents and Forms

Document Name Document Type
Form 0917-0036 WebTMA Survey Form and Instruction
0917-0036 WebTMA Survey SurveyMonkey IHS TMA Use.pdf Form and Instruction
0917-0036 WebTMA Survey SurveyMonkey IHS TMA Use.pdf Form and Instruction
TMA Survey Request Form 2017.doc WebTMA Survey Request Form IC Document
TMA Survey Request Form 2017.doc WebTMA Survey Request Form IC Document

Information Collection (IC) Details

IC Title:	WebTMA Survey	Agency IC Tracking Number:	75

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	WebTMA Survey	SurveyMonkey IHS TMA Use.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 75	Number of Respondents for Small Entity: 1

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
WebTMA Survey Request Form	TMA Survey Request Form 2017.doc	03/13/2017

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