We Care Survey, Fort Peck SU IHS

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⚠️ Notice: This information collection may be referencing outdated material.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 0917-0036 We Care Survey, Fort Peck SU IHS Form and Instruction
OMB 0917-0036 We Care Survey, Fort Peck SU IHS 41 - We Care Survey, Fort Peck SU IHS.docx Form and Instruction
41 - Mini-Supporting Statement for We Care Survey Fort Peck SU IHS.doc Mini-Supporting Statement for We Care Survey, Fort Peck SU IHS - 41 IC Document

Information Collection (IC) Details

IC Title:	We Care Survey, Fort Peck SU IHS	Agency IC Tracking Number:	41

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 0917-0036	We Care Survey, Fort Peck SU IHS	41 - We Care Survey, Fort Peck SU IHS.docx		No		Printable Only

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: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	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
Mini-Supporting Statement for We Care Survey, Fort Peck SU IHS - 41	41 - Mini-Supporting Statement for We Care Survey Fort Peck SU IHS.doc	05/19/2014

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