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Evaluation Survey of IHS Mandatory Pain and Opioid Training and Prescriber Habits
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: 230847
OMB.report
HHS/IHS
OMB 0917-0036
ICR 202201-0917-001
IC 230847
( )
Documents and Forms
Document Name
Document Type
Form 0917-0036
Evaluation Survey of IHS Mandatory Pain and Opioid Training and Prescriber Habits
Form and Instruction
0917-0036 Evaluation Survey
IHS DBH OpioidRxEvaluation Survey March 15 2018.docx
Form and Instruction
0917-0036 Evaluation Survey
IHS DBH OpioidRxEvaluation Survey March 15 2018.docx
Form and Instruction
IHS DBH Generic Clearance Submission March 15 2018.doc
DBH Clearance Submission for Evaluation Survey
IC Document
IHS DBH Generic Clearance Submission March 15 2018.doc
DBH Clearance Submission for Evaluation Survey
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Evaluation Survey of IHS Mandatory Pain and Opioid Training and Prescriber Habits
Agency IC Tracking Number:
83
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
Evaluation Survey
IHS DBH OpioidRxEvaluation Survey March 15 2018.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:
125
Number of Respondents for Small Entity:
0
Affected Public:
Federal Government
Percentage of Respondents Reporting Electronically:
100 %
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
125
0
0
0
0
125
Annual IC Time Burden (Hours)
21
0
0
0
0
21
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
DBH Clearance Submission for Evaluation Survey
IHS DBH Generic Clearance Submission March 15 2018.doc
03/28/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.