Information Collection

Indian Health Service Information Security Ticketing and Incident Reporting

IC 231681 under ICR 201803-0917-001 · OMB 0917-0041.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0041 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
ISTS CSIRT Form .pdf	Other-web system
ISTS Privacy Form .pdf	Other-web form
0917-F07-02b Incident response form F07-02b_IRF_Final.pdf	Form and Instruction
OMB ICR Supporting Statement A for Submission_IT Security.docx Indian Health Service Information Security Ticketing and Incident Reporting Part A	IC Document

IC Title:

Indian Health Service Information Security Ticketing and Incident Reporting

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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
Other-web system			ISTS CSIRT Form .pdf	Yes	Yes	Fillable Fileable
Other-web form			ISTS Privacy Form .pdf	Yes	Yes	Fillable Fileable
Form and Instruction	0917-F07-02b	Incident response form	F07-02b_IRF_Final.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,700

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,700	1,700
Annual IC Time Burden (Hours)	425	425
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Indian Health Service Information Security Ticketing and Incident Reporting Part A	OMB ICR Supporting Statement A for Submission_IT Security.docx	06/07/2018

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