Information Collection

Order for Health Services

IC 6559 under ICR 201302-0917-001 · OMB 0917-0002.

Documents and Forms

Document Name Document Type
Form IHS-843-1A Order for Health Services Form and Instruction
IHS-843-1A Order for Health Services IHS-843-1A -Order for Health Services-Rev-June2009.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Order for Health Services	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 136.24

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	IHS-843-1A	Order for Health Services	IHS-843-1A -Order for Health Services-Rev-June2009.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,424	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-378,624	378,624
Annual IC Time Burden (Hours)	-18,931	18,931
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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