Information Collection

IHS OEHE Customer Satisfaction Forms

IC 216465 under ICR 201804-0917-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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: Removed

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
	Program Change Due to Agency Discretion	Previously Approved
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.