Public Health in Indian Country Capacity Scan Assessment (PHICCS)

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

OMB: 0920-0879

IC ID: 232932

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0879 Public Health in Indian Country Capacity Scan Assessment (PHICCS) Form and Instruction
0920-0879 PHICCS Instrument - Web Version Attachment C - PHICCS Instrument (Web version).docx Form and Instruction
0920-0879 PHICCS Phone Administration of Instrument - Introduction Attachment E - PHICCS Phone Administration of Instrument_Introductory Language.docx Form and Instruction
0920-0879 PHICCS Phone Administration of Instrument - Word Version Attachment D - PHICCS Instrument (Word version)_revised.docx Form and Instruction
Attachment A - Respondent Breakdown.docx Respondent Breakdown IC Document
Attachment B - 2010 NIHB Tribal Public Health Profile.pdf 2010 NIHB Tribal Public Health Profile IC Document
Attachment F - ASTHO Profile Volume Three.pdf ASTHO Profile IC Document
Attachment G - NACCHO 2016 Report.pdf NACCHO - 2016 Report IC Document
Attachment I - PHICCS Email Invitation-revised.docx PHICCS - Email Invitation IC Document
Attachment J - PHICCS Email Reminder-revised.docx PHICCS - Email Reminder IC Document
Attachment K - PHICCS Phone Reminder-revised.docx PHICCDS - Phone Reminder IC Document
Attachment L - PHICCS Pre-Launch Webinar Email.docx PHICCS - Pre-Launch Webinar Email IC Document
Attachment M - PHICCS Pre-Launch Webinar.docx PHICCS - Pre-Launch Webinar IC Document
Attachment H - IHS Email of Support.docx IHS - Email of Support IC Document
PHICCS-SSA-071318-Revised - IHS Comments - 8-31-2018.docx Supporting Statement A IC Document
PHICCS-SSB-revised.docx Supporting Statement B IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Public Health in Indian Country Capacity Scan Assessment (PHICCS)	Agency IC Tracking Number:	0920-0879-18AZR

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-0879	PHICCS Instrument - Web Version	Attachment C - PHICCS Instrument (Web version).docx	NA	Yes	Yes	Fillable Fileable
Form and Instruction	0920-0879	PHICCS Phone Administration of Instrument - Introduction	Attachment E - PHICCS Phone Administration of Instrument_Introductory Language.docx	NA	No		Fillable Fileable
Form and Instruction	0920-0879	PHICCS Phone Administration of Instrument - Word Version	Attachment D - PHICCS Instrument (Word version)_revised.docx	NA	No		Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 261	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 65 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	261	261
Annual IC Time Burden (Hours)	261	261
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Respondent Breakdown	Attachment A - Respondent Breakdown.docx	09/07/2018
2010 NIHB Tribal Public Health Profile	Attachment B - 2010 NIHB Tribal Public Health Profile.pdf	09/07/2018
ASTHO Profile	Attachment F - ASTHO Profile Volume Three.pdf	09/07/2018
NACCHO - 2016 Report	Attachment G - NACCHO 2016 Report.pdf	09/07/2018
PHICCS - Email Invitation	Attachment I - PHICCS Email Invitation-revised.docx	09/07/2018
PHICCS - Email Reminder	Attachment J - PHICCS Email Reminder-revised.docx	09/07/2018
PHICCDS - Phone Reminder	Attachment K - PHICCS Phone Reminder-revised.docx	09/07/2018
PHICCS - Pre-Launch Webinar Email	Attachment L - PHICCS Pre-Launch Webinar Email.docx	09/07/2018
PHICCS - Pre-Launch Webinar	Attachment M - PHICCS Pre-Launch Webinar.docx	09/07/2018
IHS - Email of Support	Attachment H - IHS Email of Support.docx	09/07/2018
Supporting Statement A	PHICCS-SSA-071318-Revised - IHS Comments - 8-31-2018.docx	09/07/2018
Supporting Statement B	PHICCS-SSB-revised.docx	09/07/2018

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