Information Collection

VPN User Survey

IC 207443 under ICR 201301-0917-001 · OMB 0917-0036.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form OMB No. 0917-0036- VPN User Survey	Form and Instruction
OMB No. 0917-0036- OMB Form No. 0917-0036-22, IHS VPN User Survey OMB No 0917-0036-22 IHS VPN User Survey.docx www.surveymonkey.com/s/CGBDGW9	Form and Instruction
Generic Clearance Submission - IHS VPN Survey T Clay edits.doc 0917-0036-22, Mini Supporting Statement for IHS VPN User Survey	IC Document

IC Title:

VPN User Survey

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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	OMB No. 0917-0036-22	OMB Form No. 0917-0036-22, IHS VPN User Survey	OMB No 0917-0036-22 IHS VPN User Survey.docx	https://www.surveymonkey.com/s/CGBDGW9	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 220

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	220	220
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
0917-0036-22, Mini Supporting Statement for IHS VPN User Survey	Generic Clearance Submission - IHS VPN Survey T Clay edits.doc	06/17/2013

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