Information Collection

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

IC 218957 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⚠️ Notice: This information collection may be referencing outdated material.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 OMB Form No. 0917-0036, Indian Health Service (IHS) Community Health Representative (CHR) Basic Online Training Evaluation	Form and Instruction
0917-0036 IHS CHR Basic Online Training Evaluation OMB No 0917-0036-15 CHR Basic Online Training Evaluation Form (002).docx	Form and Instruction
OMB 0917-0036 Mini-Supporting Statement Basic Online Training Evaluation (003).docx Supporting Statement for OMB Form No. 0917-0036, Indian Health Service (IHS) Community Health Representative (CHR) Basic Online	IC Document

IC Title:

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

Agency IC Tracking Number:

IC Status: Removed

Obligation to Respond: Mandatory

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

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	-300	300
Annual IC Time Burden (Hours)	-25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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

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