User satisfaction data collection for the IHS OIT NDW

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⚠️ Notice: This information collection may be referencing outdated material.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 User satisfaction data collection for the IHS OIT NDW Form and Instruction
0917-0036 Indian Health Service, Office of Information Technology, Data Collection Survey Link and Screenshots.docx www.surveymonkey.com/r/NV22FLL Form and Instruction
OMB Form 0917-0036 Mini-supporting Statement for User satisfaction data collection for IHS OIT NPIRS , 2-11-2015.doc OMB No. 0917-0036, Mini-Supporting Statement for User Satisfaction Data Collection for IHS OIT NDW IC Document
NPIRS OA Data Collection Announcement.docx NPIRS OA Data Collection Announcement IC Document

Information Collection (IC) Details

IC Title:	User satisfaction data collection for the IHS OIT NDW	Agency IC Tracking Number:	0917-0036-48

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	Indian Health Service, Office of Information Technology, National Patient Reporting System National Data Warehouse Data Collection Survey	Data Collection Survey Link and Screenshots.docx	https://www.surveymonkey.com/r/NV22FLL	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 487	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	487	487
Annual IC Time Burden (Hours)	81	81
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OMB No. 0917-0036, Mini-Supporting Statement for User Satisfaction Data Collection for IHS OIT NDW	OMB Form 0917-0036 Mini-supporting Statement for User satisfaction data collection for IHS OIT NPIRS , 2-11-2015.doc	02/12/2015
NPIRS OA Data Collection Announcement	NPIRS OA Data Collection Announcement.docx	02/12/2015

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