Information Collection

FEHB/ FEGLI Implementation Questionnaire for Tribes and Tribal Organizations

IC 194771 under ICR 201010-3206-004 · OMB 3206-0251.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0 FEHB/ FEGLI Implementation Questionnaire for Tribes and Tribal Organizations	Form and Instruction
0 FEHB/ FEGLI Implementation Questionnaire for Tribes and IHS - FEHB Tribes_10-2-10_FINAL.doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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 and Instruction	0	FEHB/ FEGLI Implementation Questionnaire for Tribes and Tribal Organizations	IHS - FEHB Tribes_10-2-10_FINAL.doc		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 564

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	564	-36	600
Annual IC Time Burden (Hours)	188	-12	200
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.