Information Collection

Voluntary Customer Surveys To Implement Executive Order 12862 Within The Indian Health Service

IC 110468 under ICR 199312-0917-001 · OMB 0917-0018.

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Document Name	Document Type

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IC Title:

VOLUNTARY CUSTOMER SURVEYS TO IMPLEMENT EXECUTIVE ORDER 12862 WITHIN THE INDIAN HEALTH SERVICE

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	48,843	48,843
Annual IC Time Burden (Hours)	8,140	8,140
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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