Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: IHS Customer Service Satisfaction and Similar Surveys

Forms and Documents

Document Name	Status
Form 0917-0036-58-3 Chinle Service Unit (CSU) Health Promotion/Disease Prevention Form and Instruction	New
Form 0917-0036 Evaluation Survey of IHS Mandatory Pain and Opioid Training and Prescriber Habits Form and Instruction	New
Form 0917-0036 IHS White Earth Hand Washing Survey Form and Instruction	New
Form 0917-0036 Fort Washakie Medical Home Patient Feedback Form and Instruction	New
Form 0917-0036-12 Patient Satisfaction Survey, Optometry Dept. White Earth Service Unit Indian Health Service Form and Instruction	New
Form 0917-0036-23 IHS Training Needs Survey Form and Instruction	New
Form 0917-0036 IHS Chinle Service Unit Customer Experience Survey – Clinical and Community Nutrition Form	New
Form 0917-0036 WebTMA Survey Form and Instruction	New
Form 0917-0036 Telebehavioral Health Patient Satisfaction Survey Form	New
Form 0917-0036 Public Health Nursing Data Mart Survey Form and Instruction	New
Form 0917-0036 Patient Experience of Care Survey Pilot Project Form and Instruction	New
Form IHS Web Services C IHS Web Services Customer Satisfaction Survey Form	New
Form 0917-0036 PT/OT (Therapy Department) - Provision of Care Survey Form and Instruction	New
Form 0917-0036 OMB Form No. 0917-0036, Indian Health Service (IHS) Community Health Representative (CHR) Basic Online Training Evaluation Form and Instruction	New
Form 0917-0036 OMB Form No. 0917-0036: IHS Chinle Service Unit Customer Experience Survey, Division of Public Health. Form and Instruction	New
Form 0917-0036 Pediatric Care Unit (PCU) Patient Experience Survey, Chinle Service Unit (CSU) Form and Instruction	New
Form 0917-0036 Obstetric Care Unit (OCU) Patient Experience Survey, Chinle Service Unit Form and Instruction	New
Form 0917-0036 Special Care Unit (SCU) Patient Experience Survey, Chinle Service Unit Form and Instruction	New
Form 0917-0036 Adult Care Unit (ACU) Patient Experience Survey, Chinle Service Unit (CSU) Form and Instruction	New
Form 0917-0036 Chinle Service Unit (CSU) Employee Satisfaction Survey. Form and Instruction	New
Form 0917-0036 We Care Survey, Fort Peck Service Unit Indian Health Service Form and Instruction	New
Form 0917-0036 Clinical Decision Support Usability Assessment Form and Instruction	New
Form 0917-0036 Patient Satisfaction Survey, Crow Service Unit Form and Instruction	New
Form 0917-0036 Sugar Shockers Health Campaign Survey, Catawba Service Unit Form and Instruction	New
Form 0917-0036 User satisfaction data collection for the IHS OIT NDW Form and Instruction	New
Form 0917-0036 We Care Survey, Northern Cheyenne Form and Instruction	New
Form 0917-0036 We Care Survey, Blackfeet Community Hospital. Form and Instruction	New
Form 0917-0036 Indian Health Service (IHS) Wind River Service Unit (WRSU) Customer Satisfaction Survey Form and Instruction	New
Form 0917-0036 Catawba Service Unit Patient Satisfaction Survey Form and Instruction	New
Form 0917-0036 IHS RPMS Stakeholder Survey – Resource and Patient Management System Program Operational Analysis Needs Assessment Form and Instruction	New
Form 0917-0036 We Care Survey, Fort Peck Service Unit Indian Health Service Form and Instruction	New
Form 0917-0036 THC Dental Patient Satisfaction Survey Form and Instruction	New
Form 0917-0036 Patient Satisfaction Survey, Tohatchi Form and Instruction	New
Form 0917-0036 Gallup Service Unit Patient Satisfaction Survey Form and Instruction	New
Form 0917-0036 Patient Satisfaction Survey, Alburquerque Service Unit Form and Instruction	New
Form 0917-0036 Providers –e-RX Deployment Survey Form and Instruction	New
Form 0917-0036 White Earth Dental Clinic Patient Satisfaction Survey Form and Instruction	New
Form 0917-0036 Patient Flow Time Study Form and Instruction	New
Form 0917-0036 Patient Satisfaction Survey, at Cheyenne River Health Center (CRHC) Form and Instruction	New
Form 0917-0036 EHR Pharmacy Residence Informaticists Survey Form and Instruction	New
Form 0917-0036 eLearning Hands-on Customer Satisfaction Survey Form and Instruction	New
Form 0917-0036 Computer Based Post Class Survey Form and Instruction	New
Form 0917-0036 IHS Website ICD-10 Stakeholder Readiness Survey – ICD-10 Project Needs Assessment Form and Instruction	New
Form 0917-0036 IHS Patient Experience Survey Form and Instruction	New
Form 0917-0036 IHS RPMS Annual Training Needs Assessment Survey Form and Instruction	New
Form 0917-0036 VPN User Survey Form and Instruction	New
Form 0917-0036 Portland Area Division of Environment Health Services: Customer Service Assessment. Form and Instruction	New
Form 0917-0036 IHS OEHE Customer Satisfaction Forms Form and Instruction	New
Form 0917-0036 IHS Pharmacy Automation 2015 Survey Form and Instruction	New
Form 0917-0036 Indian Health Service (IHS) Clinical Rounds Qualitative Feedback Form and Instruction	New
Form 0917-0036 IHS CHR NET Plenary Evaluation Form Form and Instruction	New
Form 0917-0036 Indian Health Service (IHS) Community Health Representatives (CHR) Diabetes Online Training Evaluation Form and Instruction	New
Form 0917-0036 IHS Community Health Representative Basic Training & Refresher Course Training form Form and Instruction	New
Form 0917-0036 OIT Customer Satisfaction Survey – Problem Ticket Form and Instruction	New
Form 0917-0036 OIT Customer Satisfaction Survey-Service Ticket Form and Instruction	New
Form 0917-0036 Physician/Dentist Customer Service Questionnaire Form and Instruction	New
Form 0917-0036 Patient Assessment –Clinton Service Unit - IMPRESS Form and Instruction	New
Form 0917-0036 Employee Assessment- Clinton Service Unit - IMPRESS Form and Instruction	New
Form 0917-0036 Indian Health Service (IHS) FY_ Satellite Classroom Post Class Survey Form and Instruction	New
Form 0917-0036 Indian Health Service (IHS) FY_ eLearning Post Class Survey Form and Instruction	New
Form 0917-0036 Indian Health Service (IHS) FY_ Classroom Post Class Survey Form and Instruction	New
Form 0917-0036 IHS Website Customer Satisfaction Survey – EHR Survey Monkey – VIRTUAL Form and Instruction	New
Form 0917-0036 IHS Website Customer Satisfaction Survey – EHR Survey Monkey – Classroom Form Form and Instruction	New
Form 0917-0036 Indian Health Service (IHS Website Feedback Form Form and Instruction	New
FR Pubication 05-12-15.pdf Supplementary Document	2015-05-13
OMB No. 0917-0036, 60 Day FRN, Published.pdf Supplementary Document	2015-05-13
Supporting Statement for OMB No. 0917-0036, IHS Fast Track for Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery Part A - IHS FINAL 5-12-15v1.docx Supporting Statement A	2015-05-13
Justification for Burden Increase.docx Justification for No Material/Nonsubstantive Change	2013-01-18

IC Document Collections

IC ID	Document Title	Status
231605	Chinle Service Unit (CSU) Health Promotion/Disease Prevention Form and Instruction	New
230847	Evaluation Survey of IHS Mandatory Pain and Opioid Training and Prescriber Habits Form and Instruction	New
230260	IHS White Earth Hand Washing Survey Form and Instruction	New
229103	Fort Washakie Medical Home Patient Feedback Form and Instruction	New
228427	Patient Satisfaction Survey, Optometry Dept. White Earth Service Unit Indian Health Service Form and Instruction	New
227895	Innovative Session Partnership Conference Other-Discussion Questions	New
227765	IHS Training Needs Survey Form and Instruction	New
226315	IHS Chinle Service Unit Customer Experience Survey – Clinical and Community Nutrition Form	New
226049	WebTMA Survey Form and Instruction	New
225049	Telebehavioral Health Patient Satisfaction Survey Form	New
225048	Public Health Nursing Data Mart Survey Form and Instruction	New
224877	Patient Experience of Care Survey Pilot Project Form and Instruction	New
223611	IHS Web Services Customer Satisfaction Survey Form	New
221047	PT/OT (Therapy Department) - Provision of Care Survey Form and Instruction	New
218957	OMB Form No. 0917-0036, Indian Health Service (IHS) Community Health Representative (CHR) Basic Online Training Evaluation Form and Instruction	New
218239	OMB Form No. 0917-0036: IHS Chinle Service Unit Customer Experience Survey, Division of Public Health. Form and Instruction	New
217933	Pediatric Care Unit (PCU) Patient Experience Survey, Chinle Service Unit (CSU) Form and Instruction	New
217932	Obstetric Care Unit (OCU) Patient Experience Survey, Chinle Service Unit Form and Instruction	New
217748	Special Care Unit (SCU) Patient Experience Survey, Chinle Service Unit Form and Instruction	New
217747	Adult Care Unit (ACU) Patient Experience Survey, Chinle Service Unit (CSU) Form and Instruction	New
217690	Chinle Service Unit (CSU) Employee Satisfaction Survey. Form and Instruction	New
217673	We Care Survey, Fort Peck Service Unit Indian Health Service Form and Instruction	New
216572	Clinical Decision Support Usability Assessment Form and Instruction	New
216564	Patient Satisfaction Survey, Crow Service Unit Form and Instruction	New
216563	Sugar Shockers Health Campaign Survey, Catawba Service Unit Form and Instruction	New
216545	User satisfaction data collection for the IHS OIT NDW Form and Instruction	New
216544	We Care Survey, Northern Cheyenne Form and Instruction	New
216538	We Care Survey, Blackfeet Community Hospital. Form and Instruction	New
216534	Indian Health Service (IHS) Wind River Service Unit (WRSU) Customer Satisfaction Survey Form and Instruction	New
216532	Catawba Service Unit Patient Satisfaction Survey Form and Instruction	New
216531	IHS RPMS Stakeholder Survey – Resource and Patient Management System Program Operational Analysis Needs Assessment Form and Instruction	New
216529	We Care Survey, Fort Peck Service Unit Indian Health Service Form and Instruction	New
216517	THC Dental Patient Satisfaction Survey Form and Instruction	New
216516	Patient Satisfaction Survey, Tohatchi Form and Instruction	New
216515	Gallup Service Unit Patient Satisfaction Survey Form and Instruction	New
216514	Patient Satisfaction Survey, Alburquerque Service Unit Form and Instruction	New
216513	Providers –e-RX Deployment Survey Form and Instruction	New
216512	White Earth Dental Clinic Patient Satisfaction Survey Form and Instruction	New
216510	Patient Flow Time Study Form and Instruction	New
216509	Patient Satisfaction Survey, at Cheyenne River Health Center (CRHC) Form and Instruction	New
216501	EHR Pharmacy Residence Informaticists Survey Form and Instruction	New
216500	eLearning Hands-on Customer Satisfaction Survey Form and Instruction	New
216499	Computer Based Post Class Survey Form and Instruction	New
216498	IHS Website ICD-10 Stakeholder Readiness Survey – ICD-10 Project Needs Assessment Form and Instruction	New
216493	IHS Patient Experience Survey Form and Instruction	New
216478	IHS RPMS Annual Training Needs Assessment Survey Form and Instruction	New
216474	VPN User Survey Form and Instruction	New
216470	Portland Area Division of Environment Health Services: Customer Service Assessment. Form and Instruction	New
216465	IHS OEHE Customer Satisfaction Forms Form and Instruction	New
216464	IHS Pharmacy Automation 2015 Survey Form and Instruction	New
216462	Indian Health Service (IHS) Clinical Rounds Qualitative Feedback Form and Instruction	New
216457	IHS CHR NET Plenary Evaluation Form Form and Instruction	New
216453	Indian Health Service (IHS) Community Health Representatives (CHR) Diabetes Online Training Evaluation Form and Instruction	New
216452	IHS Community Health Representative Basic Training & Refresher Course Training form Form and Instruction	New
216429	OIT Customer Satisfaction Survey – Problem Ticket Form and Instruction	New
216427	OIT Customer Satisfaction Survey-Service Ticket Form and Instruction	New
216426	Physician/Dentist Customer Service Questionnaire Form and Instruction	New
216424	Patient Assessment –Clinton Service Unit - IMPRESS Form and Instruction	New
216421	Employee Assessment- Clinton Service Unit - IMPRESS Form and Instruction	New
216417	Indian Health Service (IHS) FY_ Satellite Classroom Post Class Survey Form and Instruction	New
216415	Indian Health Service (IHS) FY_ eLearning Post Class Survey Form and Instruction	New
216412	Indian Health Service (IHS) FY_ Classroom Post Class Survey Form and Instruction	New
216402	IHS Website Customer Satisfaction Survey – EHR Survey Monkey – VIRTUAL Form and Instruction	New
216397	IHS Website Customer Satisfaction Survey – EHR Survey Monkey – Classroom Form Form and Instruction	New
216396	Indian Health Service (IHS Website Feedback Form Form and Instruction	New

ICR Details

OMB Control No: 0917-0036	ICR Reference No: 201504-0917-007
Status: Historical Active	Previous ICR Reference No: 201301-0917-001
Agency/Subagency: HHS/IHS	Agency Tracking No: 1
Title: Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: IHS Customer Service Satisfaction and Similar Surveys
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/28/2015
	Date Received in OIRA: 05/13/2015
Terms of Clearance: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2018	36 Months From Approved	07/31/2015
Responses	105,000	0	105,000
Time Burden (Hours)	17,500	0	40,000
Cost Burden (Dollars)	0	0	0

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Abstract: This fast track generic collection of information is neccesssary to enable IHS to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficient, and satisfying experience with the Agency's programs.

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Authorizing Statute(s): US Code: 44 USC 3501 Name of Law: Paperwork Reduction Act
   EO: EO 12862 Name/Subject of EO: SETTING CUSTOMER SERVICE STANDARDS
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 11206	03/02/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 27176	05/12/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 65

IC Title	Form No.	Form Name
User satisfaction data collection for the IHS OIT NDW	0917-0036	Indian Health Service, Office of Information Technology, National Patient Reporting System National Data Warehouse Data Collection Survey
Gallup Service Unit Patient Satisfaction Survey	0917-0036	Gallup Service Unit Patient Satisfaction Survey
Patient Satisfaction Survey, Tohatchi	0917-0036	Patient Satisfaction Survey, Tohatchi
Indian Health Service (IHS) Clinical Rounds Qualitative Feedback	0917-0036	Indian Health Service (IHS) Clinical Rounds Qualitative Feedback
Physician/Dentist Customer Service Questionnaire	0917-0036	Physician/Dentist Customer Service Questionnaire
Clinical Decision Support Usability Assessment	0917-0036	Clinical Decision Support Usability Assessment
Patient Satisfaction Survey, Crow Service Unit	0917-0036	Patient Satisfaction Survey, Crow Service Unit
OMB Form No. 0917-0036: IHS Chinle Service Unit Customer Experience Survey, Division of Public Health.	0917-0036, 0917-0036, 0917-0036, 0917-0036, 0917-0036, 0917-0036, 0917-0036, 0917-0036	Wellness Center Survey ,   Adolescent School Health ,   Community Nutrition Survey ,   Diabetes Survey ,   Health Promotion Survey ,   Native Medicine Survey ,   Public Health Nursing - for Patient Care Giver - Survey ,   Public Health Nursing - for Patient
Pediatric Care Unit (PCU) Patient Experience Survey, Chinle Service Unit (CSU)	0917-0036	Pediatric Care Unit (PCU) Patient Experience Survey, Chinle Service Unit CSU)
VPN User Survey	0917-0036	VPN User Survey
EHR Pharmacy Residence Informaticists Survey	0917-0036	EHR Pharmacy Residence Informaticists Survey
Catawba Service Unit Patient Satisfaction Survey	0917-0036	Catawba Service Unit Patient Satisfaction Survey
Providers –e-RX Deployment Survey	0917-0036	Providers - e-RX Deployment Survey
IHS Chinle Service Unit Customer Experience Survey – Clinical and Community Nutrition	0917-0036, 0917-0036	Community Nutrition Gardening Survey ,   RDN Services Survey
Innovative Session Partnership Conference
Employee Assessment- Clinton Service Unit - IMPRESS	0917-0036	Employee Assessment- Clinton Service Unit - IMPRESS
Indian Health Service (IHS Website Feedback Form	0917-0036, 0917-0036	IHS Website Customer Satisfaction Survey - First Page ,   IHS Website Feedback Form
OIT Customer Satisfaction Survey – Problem Ticket	0917-0036, 0917-0036	OIT Customer Satisfaction Survey – Problem Ticket ,   OIT Customer Satisfaction Survey – Problem Ticket (screen shot)
IHS Community Health Representative Basic Training & Refresher Course Training form	0917-0036	IHS Community Health Representative Basic Training & Refresher Course Training form
Sugar Shockers Health Campaign Survey, Catawba Service Unit	0917-0036	Sugar Shockers Health Campaign Survey, Catawba Service Unit
Indian Health Service (IHS) FY_ Satellite Classroom Post Class Survey	0917-0036, 0917-0036	Indian Health Service (IHS) FY_ Satellite Classroom Post Class Survey ,   FY___Satellite Classroom with Areas Post Class Survey
Obstetric Care Unit (OCU) Patient Experience Survey, Chinle Service Unit	0917-0036	Obstetrical Care Unit (OCU) Patient Experience Suvey, Chinle Service Unit (CSU)
Telebehavioral Health Patient Satisfaction Survey	0917-0036	Telebehavioral Health Patient Satisfaction Survey
We Care Survey, Fort Peck Service Unit Indian Health Service	0917-0036	We Care Survey, Fort Peck Service Unit, Indian Health Service
Evaluation Survey of IHS Mandatory Pain and Opioid Training and Prescriber Habits	0917-0036	Evaluation Survey
Patient Flow Time Study	0917-0036	Patient Flow Time Study
White Earth Dental Clinic Patient Satisfaction Survey	0917-0036	White Earth Dental Clinic Patient Satisfaction Survey
IHS RPMS Stakeholder Survey – Resource and Patient Management System Program Operational Analysis Needs Assessment	0917-0036	Indian Health Service (IHS) RPMS Stakeholder Survey – Resource and Patient Management System Program Operational Analysis Needs Assessment
Public Health Nursing Data Mart Survey	0917-0036	Public Health Nursing (PHN) Data Mart Survey Questions
Fort Washakie Medical Home Patient Feedback	0917-0036	Fort Washakie Medical Home Patient Feedback
Portland Area Division of Environment Health Services: Customer Service Assessment.	0917-0036	Portland Area Division of Environment Health Services: Customer Service Assessment.
IHS Website ICD-10 Stakeholder Readiness Survey – ICD-10 Project Needs Assessment	0917-0036	IHS Website ICD-10 Stakeholder Readiness Survey – ICD-10 Project Needs Assessment
Indian Health Service (IHS) Wind River Service Unit (WRSU) Customer Satisfaction Survey	0917-0036, 0917-0036, 0917-0036	Coordinated Care Survey ,   Patient Registration Suvey ,   Patient Wellness Survey
IHS CHR NET Plenary Evaluation Form	0917-0036	IHS CHR NET Plenary Evaluation Form
IHS Web Services Customer Satisfaction Survey	IHS Web Services Customer Feedback	IHS Web Services Customer Feedback
WebTMA Survey	0917-0036	WebTMA Survey
Computer Based Post Class Survey	0917-0036	Computer Based Training (CBT)Post Class Survey
Patient Satisfaction Survey, at Cheyenne River Health Center (CRHC)	0917-0036	Patient Satisfaction Survey, at Cheyenne River Health Center (CRHC)
eLearning Hands-on Customer Satisfaction Survey	0917-0036	eLearning Hands-on Customer Satisfaction survey
IHS Patient Experience Survey	0917-0036	IHS Patient Experience Survey
IHS Website Customer Satisfaction Survey – EHR Survey Monkey – Classroom Form	0917-0036	IHS Website Customer Satisfaction Survey – EHR Survey Monkey – Classroom Form
IHS Website Customer Satisfaction Survey – EHR Survey Monkey – VIRTUAL	0917-0036	IHS Website Customer Satisfaction Survey – EHR Survey Monkey – VIRTUAL
We Care Survey, Northern Cheyenne	0917-0036	We Care Patient Satisfaction Survey for Northern Cheyenne
Indian Health Service (IHS) Community Health Representatives (CHR) Diabetes Online Training Evaluation	0917-0036	Indian Health Service (IHS) Community Health Representatives (CHR) Diabetes Online Training Evaluation
OIT Customer Satisfaction Survey-Service Ticket	0917-0036, 0917-0036	OIT Customer Satisfaction Survey-Service Ticket ,   OIT Customer Satisfaction Survey-Service Ticket (screen shot)
Adult Care Unit (ACU) Patient Experience Survey, Chinle Service Unit (CSU)	0917-0036	Adult Care Unit (ACU) Patient Experience Survey, Chinle Service Unit
Chinle Service Unit (CSU) Employee Satisfaction Survey.	0917-0036	CSU Employee Survey 2015
Special Care Unit (SCU) Patient Experience Survey, Chinle Service Unit	0917-0036	Special Care Unit (SCU) Patient Experience Survey
IHS White Earth Hand Washing Survey	0917-0036	Hand Washing Survey
Patient Assessment –Clinton Service Unit - IMPRESS	0917-0036	Patient Assessment –Clinton Service Unit - IMPRESS
IHS OEHE Customer Satisfaction Forms	0917-0036, 0917-0036, 0917-0036, 0917-0036	Annual Operator O & M Survey ,   Post-Construction O & M Survey ,   Tribal Homeowner Survey ,   Tribal Partner Survey
We Care Survey, Blackfeet Community Hospital.	0917-0036	We Care Survey, Blackfeet Community Hospital.
IHS Pharmacy Automation 2015 Survey	0917-0036	IHS Pharmacy Automation 2015 Survey
Indian Health Service (IHS) FY_ Classroom Post Class Survey	0917-0036	Indian Health Service (IHS) FY_ Classroom Post Class Survey
OMB Form No. 0917-0036, Indian Health Service (IHS) Community Health Representative (CHR) Basic Online Training Evaluation	0917-0036	IHS CHR Basic Online Training Evaluation
Patient Experience of Care Survey Pilot Project	0917-0036	Patient Experience of Care Survey
Patient Satisfaction Survey, Optometry Dept. White Earth Service Unit Indian Health Service	0917-0036-12	Patient Satisfaction Survey for the White Earth Optometry Dept.
Chinle Service Unit (CSU) Health Promotion/Disease Prevention	0917-0036-58-3	CSU Health Promotion survey
We Care Survey, Fort Peck Service Unit Indian Health Service	0917-0036	We Care Survey, Fort Peck Service Unit Indian Health Service
THC Dental Patient Satisfaction Survey	0917-0036	THC Dental Patient Satisfaction Survey
Patient Satisfaction Survey, Alburquerque Service Unit	0917-0036	Patient Satisfaction Survey, Alburquerque Service Unit
IHS RPMS Annual Training Needs Assessment Survey	0917-0036	IHS RPMS Annual Training Needs Assessment Survey
Indian Health Service (IHS) FY_ eLearning Post Class Survey	0917-0036	Indian Health Service (IHS) FY_ eLearning Post Class Survey
PT/OT (Therapy Department) - Provision of Care Survey	0917-0036	PT/OT (Therapy Department) - Provision of Care Survey
IHS Training Needs Survey	0917-0036-23	Training Needs Survey

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	105,000	105,000	0	0	0	0
Annual Time Burden (Hours)	17,500	40,000	0	0	-22,500	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a request for an extension of a previously approved generic ICR. There were no program changes. However, there was a change in burden hours due to adjustments in the Agency's estimate. The number of total burden hours was reduced (from 40,000 burden hours to 17,500) to more accurately reflect the actual burden hours. The increase in costs (from $15,000 to $25,000) to the Federal government was also modified to more accurately reflect the actual and projected costs for the next three years.

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Annual Cost to Federal Government: $25,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/13/2015

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