Information Collection

User satisfaction data collection for the IHS OIT NDW

IC 214984 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⚠️ Notice: This information collection may be referencing outdated material.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 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

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:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.