IHS Clinical Rounds Qualitative Feedback

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⚠️ Notice: This information collection may be referencing outdated material.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 0917-0036-18 IHS Clinical Rounds Qualitative Feedback Form and Instruction
0917-0036-18 0917-0036-18, IHS Clinical Rounds Qualitative Feedback F IHS Clinical Rounds Qualitative Feedback - Survey Monkey - VIRTUAL FORM 4-8-2013.pdf Form and Instruction
OMB No 0917-0036-018 - Mini-Supporting Statement for IHS Clinical Rounds Qualitative Feedback Form.pdf OMB No 0917-0036-018 - Mini-Supporting Statement for IHS Clinical Rounds Qualitative Feedback Form IC Document

Information Collection (IC) Details

IC Title:	IHS Clinical Rounds Qualitative Feedback	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	0917-0036-18	0917-0036-18, IHS Clinical Rounds Qualitative Feedback Form	IHS Clinical Rounds Qualitative Feedback - Survey Monkey - VIRTUAL FORM 4-8-2013.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	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	500	500
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB No 0917-0036-018 - Mini-Supporting Statement for IHS Clinical Rounds Qualitative Feedback Form	OMB No 0917-0036-018 - Mini-Supporting Statement for IHS Clinical Rounds Qualitative Feedback Form.pdf	03/26/2013

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