Information Collection

Indian Health Service Contract Health Service Reports

IC 6556 under ICR 199609-0917-001 · OMB 0917-0002.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0002 can be found here:

Documents and Forms

Document Name Document Type

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Information Collection (IC) Details

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IC Title:	Indian Health Service Contract Health Service Reports	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	64-1A	No	No
Form	57-1A	No	No
Form	IHS-43-1A	No	No
Form	843-1A	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 13,200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	591,026	591,026
Annual IC Time Burden (Hours)	61,821	61,821
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

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