Information Collection

Indian Health Service (IHS) Wind River Service Unit (WRSU) Customer Satisfaction Survey

IC 216534 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⚠️ Notice: This information collection may be referencing outdated material.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 Indian Health Service (IHS) Wind River Service Unit (WRSU) Customer Satisfaction Survey	Form and Instruction
0917-0036 Coordinated Care Survey Coordinated Care PT Satisfaction Survey_2015.pdf	Form and Instruction
0917-0036 Patient Registration Suvey Patient Registration Survey_2015.pdf	Form and Instruction
0917-0036 Patient Wellness Survey Patient Wellness Satisfaction Survey_2015_revisions.pdf	Form and Instruction
FINAL OMB No 0917-0036-Supporting Statement for IHS WRSU 2015.doc OMB No. 0917-0036, Mini-Supporting Statement for Indian Health Service (IHS) Wind River Service Unit (WRSU) Customer Satisfactio	IC Document

IC Title:

Indian Health Service (IHS) Wind River Service Unit (WRSU) Customer Satisfaction Survey

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	Coordinated Care Survey	Coordinated Care PT Satisfaction Survey_2015.pdf	Yes	Yes	Fillable Printable
Form and Instruction	0917-0036	Patient Registration Suvey	Patient Registration Survey_2015.pdf	Yes	Yes	Fillable Printable
Form and Instruction	0917-0036	Patient Wellness Survey	Patient Wellness Satisfaction Survey_2015_revisions.pdf	Yes	Yes	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: 5 %

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)	-150	150
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 Indian Health Service (IHS) Wind River Service Unit (WRSU) Customer Satisfaction Survey	FINAL OMB No 0917-0036-Supporting Statement for IHS WRSU 2015.doc	05/11/2015

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