42 CFR PART 36, ELIGIBILITY FOR INDIAN HEALTH SERVICE SERVICES--NPRM

ICR 198806-0917-006

OMB: 0917-0008

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0917-0008 198806-0917-006
Historical Active
HHS/IHS
42 CFR PART 36, ELIGIBILITY FOR INDIAN HEALTH SERVICE SERVICES--NPRM
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 06/10/1988
Retrieve Notice of Action (NOA) 06/10/1988
  Inventory as of this Action Requested Previously Approved
06/30/1989 06/30/1989
1 0 0
1 0 0
0 0 0

TO APPLY FOR ELIGIBILITY TO RECEIVE IHS DIRECT OR CONTRACT HEALTH SERVICES, A PERSON MUST SUBMIT EVIDENCE OF TRIBAL RELATIONSHIP, INDIAN BLOOD QUANTUM AND RESIDENCE WITHIN AN IHS HEALTH SERVICE DELIVERY AREA. A TRIBAL GOVERNING BODY MAY REQUEST A CHANGE IHS HEALTH SERVICE DELIVERY AREAS SUPPORTED BY DOCUMENTATION SPECIFIED IN PROPOSED 42 CFR 36.15(B) (1-5).

None
None


No

1
IC Title Form No. Form Name
42 CFR PART 36, ELIGIBILITY FOR INDIAN HEALTH SERVICE SERVICES--NPRM

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 1 0 0 0 1 0
Annual Time Burden (Hours) 1 0 0 0 1 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/10/1988


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