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Information Collection

IHS Chinle Service Unit Customer Experience Survey – Clinical and Community Nutrition

IC 226315 under ICR 201804-0917-001 · OMB 0917-0036.

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Form
Form
IC Document
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Information Collection (IC) Details

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IHS Chinle Service Unit Customer Experience Survey – Clinical and Community Nutrition 58
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 0917-0036 Community Nutrition Gardening Survey 2017 Community Nutrition Gardening survey new.docx No   Paper Only
Form 0917-0036 RDN Services Survey 2017 RDN ServicesSurvey.docx No   Paper Only

Health Health Care Services

 

1,800 1
   
Individuals or Households
 
   0 %

  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 1,800 0 0 0 0 1,800
Annual IC Time Burden (Hours) 90 0 0 0 0 90
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
RDN protocol worksheet RDNSurveyProtocol Worksheet.2017.docx 04/13/2017
CN Gardening Survey protocol CN Gardening Survey protocol.docx 04/13/2017
Public Health Clearance Submission for clinical and community nutrition Public Health Clearance Submission for Clinical and Community Nutrition 3.2.17.docx 04/13/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.