OMB Form No. 0917-0036, Indian Health Service (IHS) Community Health Representative (CHR) Basic Online Training Evaluation

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

OMB: 0917-0036

IC ID: 218957

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Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
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OMB Form No. 0917-0036, Indian Health Service (IHS) Community Health Representative (CHR) Basic Online Training Evaluation 59
 
Removed
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0917-0036 IHS CHR Basic Online Training Evaluation OMB No 0917-0036-15 CHR Basic Online Training Evaluation Form (002).docx Yes Yes Fillable Fileable

Health Health Care Services

 

300 0
   
Individuals or Households
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 0 0 -300 0 0 300
Annual IC Time Burden (Hours) 0 0 -25 0 0 25
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement for OMB Form No. 0917-0036, Indian Health Service (IHS) Community Health Representative (CHR) Basic Online Training Evaluation OMB 0917-0036 Mini-Supporting Statement Basic Online Training Evaluation (003).docx 11/12/2015
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