FEHB/ FEGLI Implementation Questionnaire for Urban Indian Organizations

DISTRIBUTION OF FEHB/FEGLI IMPLEMENTATION QUESTIONNAIRES TO TRIBES AND URBAN INDIAN ORGANIZATIONS

Documents and Forms

Document Name Document Type
Form 0 FEHB/ FEGLI Implementation Questionnaire for Urban Indian Organizations Form and Instruction
0 FEHB/ FEGLI Implementation Questionnaire for Urban India IHS - FEHB Urbans_10-4-10_DRAFT.doc Form and Instruction

Information Collection (IC) Details

IC Title:	FEHB/ FEGLI Implementation Questionnaire for Urban Indian Organizations	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 Urban Indian Organizations	IHS - FEHB Urbans_10-4-10_DRAFT.doc		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 65	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	65	65
Annual IC Time Burden (Hours)	22	22
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.