IHS Contract Health Service Report

Forms and Documents

Document Name	Status
Form IHS-843-1A IHS Contract Health Service Report Form and Instruction	Modified
2006revisedsupportingstatement.doc Supporting Statement A	2006-10-04

IC Document Collections

IC ID	Document Title	Status
6559	IHS Contract Health Service Report Form and Instruction	Modified
46026	Indian Health Service Contract Health Service Report	New

ICR Details

OMB Control No: 0917-0002	ICR Reference No: 200611-0917-001
Status: Historical Active	Previous ICR Reference No: 200307-0917-001
Agency/Subagency: HHS/IHS	Agency Tracking No:
Title: IHS Contract Health Service Report
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/11/2007
	Date Received in OIRA: 11/15/2006
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2010	36 Months From Approved	01/31/2007
Responses	324,475	0	338,403
Time Burden (Hours)	16,224	0	16,920
Cost Burden (Dollars)	0	0	0

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Abstract: Respondents certify that they have performed the health care services authorized by the IHS. Information is used to manage, administer, and plan for the provision health care services to eligible American Indians, process payments to providers, obtain program data, provide program statistics, and serve as a legal document for health care services rendered.

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Authorizing Statute(s): PL: Pub.L. 42 - 83 568 Name of Law: The Transfer Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 39686	07/13/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	71 FR 55495	09/22/2006
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Indian Health Service Contract Health Service Report
IHS Contract Health Service Report	IHS-843-1A	Order for Health Services

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ICR Summary of Burden

	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	324,475	338,403	0	-13,928	0	0
Annual Time Burden (Hours)	16,224	16,920	0	-696	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Cutting Redundancy

Short Statement: The decrease in burden hours is a result of cutting redundancy.

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Annual Cost to Federal Government: $613,693

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 11/08/2006

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