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

Fast Track Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: IHS Customer Service Satisfaction and Similar Surveys

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0917-0036 can be found here:

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Indian Health Service (IHS) Wind River Service Unit (WRSU) Customer Satisfaction Survey	Agency IC Tracking Number:	45

IC Status: Removed

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.