Information Collection

IHS Background Investigation of Individuals in Positions Involving Regular Contact with or Control Over Indian Children

IC 6586 under ICR 201509-0917-001 · OMB 0917-0028.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0028 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0917-0028 IHS Background Investigation of Individuals in Positions Involving Regular Contact with or Control Over Indian Children	Form and Instruction
0917-0028 Final Addendum to Declaration for Federal Employment (OF Final_Addendum to Declaration for Federal Employment (OF 306) FORM1 OMS TSS REV 08182015 (1).doc www.ihs.gov/Jobs/index.cfm?module=support	Form and Instruction
OMB Form No. 3206-0182 0306[1].pdf Declaration for Federal Employment (OPM OF 306; OMB No. 3206-0182)	IC Document
FINAL Draft 0917-0028 FR 60 Day Notice rg 6-4-15.docx 60 Day Federal Register Notice for 0917-0028, Addendum to Declaration for Federal Employment, Child Care and Indian Child Care W	IC Document
FINAL 0917-0028 FR 30 Day Notice 8-05-2015 with dra edit 08-06-15 - accepted by T.Clay.docx 30 Day Federal Register Notice for OMB No. 0917-0028, Addendum to Declaration for Federal Employment, Child Care and Indian Chil	IC Document
FINAL OMB No. 0917-0028 Supporting Statement, 9-24-2015.doc OMB No. 0917-0028, Supporting Statement for IHS Background Investigation of Individuals in Positions Involving Regular Contact w	IC Document

IC Title:

IHS Background Investigation of Individuals in Positions Involving Regular Contact with or Control Over Indian Children

Agency IC Tracking Number:

0917-0028

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 136.401-418

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	0917-0028	Final Addendum to Declaration for Federal Employment (OF 360) Form, IHS Child Care Positions	Final_Addendum to Declaration for Federal Employment (OF 306) FORM1 OMS TSS REV 08182015 (1).doc	http://www.ihs.gov/Jobs/index.cfm?module=support	Yes	No	Fillable Printable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	600	600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Declaration for Federal Employment (OPM OF 306; OMB No. 3206-0182)	OMB Form No. 3206-0182 0306[1].pdf	06/11/2012
60 Day Federal Register Notice for 0917-0028, Addendum to Declaration for Federal Employment, Child Care and Indian Child Care Worker Positions	FINAL Draft 0917-0028 FR 60 Day Notice rg 6-4-15.docx	09/11/2015
30 Day Federal Register Notice for OMB No. 0917-0028, Addendum to Declaration for Federal Employment, Child Care and Indian Child Care Worker Positions	FINAL 0917-0028 FR 30 Day Notice 8-05-2015 with dra edit 08-06-15 - accepted by T.Clay.docx	09/11/2015
OMB No. 0917-0028, Supporting Statement for IHS Background Investigation of Individuals in Positions Involving Regular Contact with or Control Over Indian Children	FINAL OMB No. 0917-0028 Supporting Statement, 9-24-2015.doc	09/24/2015

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