Information Collection

We Care Survey, Fort Peck Service Unit Indian Health Service

IC 216529 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⚠️ Notice: This information collection may be referencing outdated material.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 We Care Survey, Fort Peck Service Unit Indian Health Service	Form and Instruction
0917-0036 We Care Survey, Fort Peck Service Unit Indian Health Ser 41 - We Care Survey, Fort Peck SU IHS.docx	Form and Instruction
41 - Mini-Supporting Statement for We Care Survey Fort Peck SU IHS.doc OMB No. 0917-0036, mini-Supporting Statement for We Care Survey, Fort Peck Service Unit Indian Health Service	IC Document

IC Title:

We Care Survey, Fort Peck Service Unit Indian Health Service

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0917-0036	We Care Survey, Fort Peck Service Unit Indian Health Service	41 - We Care Survey, Fort Peck SU IHS.docx		Yes	No	Fillable Printable

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: 0 %

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 We Care Survey, Fort Peck Service Unit Indian Health Service	41 - Mini-Supporting Statement for We Care Survey Fort Peck SU IHS.doc	05/11/2015

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