Information Collection

IHS Health Promotion/Disease Prevention Grantee Survey

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

Documents and Forms

Document Name Document Type
IHS Health Promotion/Disease Prevention Grantee Survey Form
survey IHS Health Promotion-Disease Prevention Grantee Survey.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	IHS Health Promotion/Disease Prevention Grantee Survey	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:

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 %

	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

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.