Information Collection

IHS Contract Health Service Report

IC 6559 under ICR 200611-0917-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form IHS-843-1A IHS Contract Health Service Report	Form and Instruction
IHS-843-1A Order for Health Services IHS-843-1A (6-06).pdf	Form and Instruction

IC Title:

IHS Contract Health Service Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 136.24

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
Form and Instruction	IHS-843-1A	Order for Health Services	IHS-843-1A (6-06).pdf		Yes	Yes	Fillable Printable

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 7,399

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	310,758	-27,645	338,403
Annual IC Time Burden (Hours)	15,538	-1,382	16,920
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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