Indian Health Service National Health Coaching Pilot Project Registration

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 Indian Health Service National Health Coaching Pilot Project Registration Form and Instruction
0917-0036 HCW Application HWC Web Content questions 11.16.21 final.docx Form and Instruction
0917-0036 HCW Application HWC Web Content questions 11.16.21 final.docx Form and Instruction
DCCS-NHCPP Registration Clearance Submission Request-IHS 11.16.21 final.docx Submission Template HWC IC Document
DCCS-NHCPP Registration Clearance Submission Request-IHS 11.16.21 final.docx Submission Template HWC IC Document

Information Collection (IC) Details

IC Title:	Indian Health Service National Health Coaching Pilot Project Registration	Agency IC Tracking Number:

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	HCW Application	HWC Web Content questions 11.16.21 final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Submission Template HWC	DCCS-NHCPP Registration Clearance Submission Request-IHS 11.16.21 final.docx	11/17/2021

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