Community Health Representatives (CHR) Online Diabetes Training Evaluation

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0036 can be found here:

Documents and Forms

Document Name Document Type
Form OMB No. 0917-0036- Community Health Representatives (CHR) Online Diabetes Training Evaluation Form and Instruction
OMB No. 0917-0036- OMB No. 0917-0036-16, IHS CHR Online Diabetes Training E OMB No. 0917-0036-16, IHS CHR Diabetes Online Training Evaluation Form.docx Form and Instruction
Signed OMB No. 0917-0036-16.pdf OMB No. 0917-0036-16, Signed Mini-Supporting Statement IC Document
OMB 0917-0036-16 IHS CHR Diabetes Online Training Evaluation - FINAL 1-29-13.docx OMB No. 0917-0036-0016 IC Document

Information Collection (IC) Details

IC Title:	Community Health Representatives (CHR) Online Diabetes Training Evaluation	Agency IC Tracking Number:

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	OMB No. 0917-0036-16	OMB No. 0917-0036-16, IHS CHR Online Diabetes Training Evaluation Form	OMB No. 0917-0036-16, IHS CHR Diabetes Online Training Evaluation Form.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 110	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	110	110
Annual IC Time Burden (Hours)	9	9
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB No. 0917-0036-16, Signed Mini-Supporting Statement	Signed OMB No. 0917-0036-16.pdf	01/29/2013
OMB No. 0917-0036-0016	OMB 0917-0036-16 IHS CHR Diabetes Online Training Evaluation - FINAL 1-29-13.docx	01/29/2013

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