Information Collection

IHS Health Promotion/Disease Prevention Grantee Survey

IC 187747 under ICR 200901-0917-001 · OMB 0917-0033.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
IHS Health Promotion/Disease Prevention Grantee Survey	Form
survey IHS Health Promotion-Disease Prevention Grantee Survey.doc	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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
Form	none	survey	IHS Health Promotion-Disease Prevention Grantee Survey.doc		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 256

Number of Respondents for Small Entity: 3

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	256	256
Annual IC Time Burden (Hours)	256	256
Annual IC Cost Burden (Dollars)	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.