IHS OEHE Customer Satisfaction Survey

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⚠️ Notice: This information collection may be referencing outdated material.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 0917-0036-20 IHS OEHE Customer Satisfaction Survey Form and Instruction
0917-0036-20 0917-0036-20, Post Construction O & M Survey 0917-0036-20, Post Construction O & M Survey.doc Form and Instruction
0917-0036-20 0917-0036-20, Annual Operator O & M Survey 0917-0036-20, Annual Operator O & M Survey.doc Form and Instruction
0917-0036-20 0917-0036-20, Tribal Homeowner Survey 0917-0036-20, Tribal Homeowner Survey.doc Form and Instruction
0917-0036-20 0917-0036-20, Tribal Partner Survey 0917-0036-20, Tribal Partner Survey.doc Form and Instruction
OMB No. 0917-0036-20, Mini-Supporting Statement for IHS OEHE customer awareness.doc : OMB No. 0917-0036-20, Mini-Supporting Statement for IHS Customer Satisfaction Survey IC Document

Information Collection (IC) Details

IC Title:	IHS OEHE Customer Satisfaction Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0917-0036-20	0917-0036-20, Post Construction O & M Survey	0917-0036-20, Post Construction O & M Survey.doc	Yes	Yes	Fillable Fileable
Form and Instruction	0917-0036-20	0917-0036-20, Annual Operator O & M Survey	0917-0036-20, Annual Operator O & M Survey.doc	Yes	Yes	Fillable Fileable
Form and Instruction	0917-0036-20	0917-0036-20, Tribal Homeowner Survey	0917-0036-20, Tribal Homeowner Survey.doc	Yes	Yes	Fillable Fileable
Form and Instruction	0917-0036-20	0917-0036-20, Tribal Partner Survey	0917-0036-20, Tribal Partner Survey.doc	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,800	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 20 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,800	1,800
Annual IC Time Burden (Hours)	90	90
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
: OMB No. 0917-0036-20, Mini-Supporting Statement for IHS Customer Satisfaction Survey	OMB No. 0917-0036-20, Mini-Supporting Statement for IHS OEHE customer awareness.doc	01/30/2013

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