Information Collection

IHS Background Investigation of Individuals in Positions Involving Regular Contact with or Control Over Indian Children

IC 6586 under ICR 201209-0917-001 · OMB 0917-0028.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0028 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0917-0028 IHS Background Investigation of Individuals in Positions Involving Regular Contact with or Control Over Indian Children	Form and Instruction
0917-0028 Final_OMB_0917-0028_2015_Version_7-10-2012.doc www.ihs.gov/Jobs/permanentDocs/ChildcareAddendumOMBApprovedForm-2012.doc	Form and Instruction
OMB Form No. 3206-0182 0306[1].pdf Declaration for Federal Employment (OPM OF 306; OMB No. 3206-0182)	IC Document

IC Title:

IHS Background Investigation of Individuals in Positions Involving Regular Contact with or Control Over Indian Children

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 136.401-418

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	0917-0028	Addendum to Declaration for Federal Employment (OF 306) ; IHS Child Care and Indian Child Care Worker Positions"	Final_OMB_0917-0028_2015_Version_7-10-2012.doc	http://www.ihs.gov/Jobs/permanentDocs/ChildcareAddendumOMBApprovedForm-2012.doc	Yes	No	Printable Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,000	0	3,000
Annual IC Time Burden (Hours)	600	-150	750
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Declaration for Federal Employment (OPM OF 306; OMB No. 3206-0182)	OMB Form No. 3206-0182 0306[1].pdf	06/11/2012

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