Health Promotion Disease Prevention Activities Registration

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: 248668

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Health Promotion Disease Prevention Activities Registration
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 9017 9017 2021 Virtual JMI Survey Monkey Registration_7.01.21.pdf Yes Yes Fillable Fileable

Health Health Care Services

 

120 0
   
Individuals or Households
 
   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 120 0 0 0 0 120
Annual IC Time Burden (Hours) 10 0 0 0 0 10
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement JMI Generic Clearance Submission Template - Health Promotion Disease Prevention Activities Registration (JMI).docx 08/02/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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