Community Health Representatives (CHR) National Education Training (NET)

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⚠️ Notice: This information collection may be referencing outdated material.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 0917-0036-17 Community Health Representatives (CHR) National Education Training (NET) Form and Instruction
0917-0036-17 OMB No. 0917-0036-17, IHS CHR NET Plenary Eval Form OMB No. 0917-0036-17, IHS CHR NET Plenary Evaluation Form.doc Form and Instruction
OMB No. 0917-0036-17.pdf OMB No. 0917-0036-17, Mini-Supporting Statement IC Document

Information Collection (IC) Details

IC Title:	Community Health Representatives (CHR) National Education Training (NET)	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	0917-0036-17	OMB No. 0917-0036-17, IHS CHR NET Plenary Eval Form	OMB No. 0917-0036-17, IHS CHR NET Plenary Evaluation Form.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 325	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	325	325
Annual IC Time Burden (Hours)	43	43
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB No. 0917-0036-17, Mini-Supporting Statement	OMB No. 0917-0036-17.pdf	03/21/2013

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