Information Collection

IHS OEHE Customer Satisfaction Forms

IC 216465 under ICR 201504-0917-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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 IHS OEHE Customer Satisfaction Forms	Form and Instruction
0917-0036 Annual Operator O & M Survey 0917-0036, Annual Operator O & M Survey.doc	Form and Instruction
0917-0036 Post-Construction O & M Survey 0917-0036, Post Construction O & M Survey.doc	Form and Instruction
0917-0036 Tribal Homeowner Survey 0917-0036, Tribal Homeowner Survey.doc	Form and Instruction
0917-0036 Tribal Partner Survey 0917-0036, Tribal Partner Survey.doc	Form and Instruction
OMB No. 0917-0036, Mini-Supporting Statement for IHS OEHE customer awareness.doc OMB No. 0917-0036, Mini-Supporting Statement for IHS OEHE Customer Satisfaction Forms	IC Document

IC Title:

IHS OEHE Customer Satisfaction Forms

Agency IC Tracking Number:

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0917-0036	Annual Operator O & M Survey	0917-0036, Annual Operator O & M Survey.doc	Yes	Yes	Fillable Fileable
Form and Instruction	0917-0036	Post-Construction O & M Survey	0917-0036, Post Construction O & M Survey.doc	Yes	Yes	Fillable Fileable
Form and Instruction	0917-0036	Tribal Homeowner Survey	0917-0036, Tribal Homeowner Survey.doc	Yes	Yes	Fillable Fileable
Form and Instruction	0917-0036	Tribal Partner Survey	0917-0036, Tribal Partner Survey.doc	Yes	Yes	Fillable Fileable

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: 100 %

table that charts list of burden
	Requested	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

table that charts IC Documents
Title	Document	Date Uploaded
OMB No. 0917-0036, Mini-Supporting Statement for IHS OEHE Customer Satisfaction Forms	OMB No. 0917-0036, Mini-Supporting Statement for IHS OEHE customer awareness.doc	05/07/2015

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