VPN User 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⚠️ Notice: This information collection may be referencing outdated material.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 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

Information Collection (IC) Details

IC Title:	VPN User 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	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 %

	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

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.