Information Collection

Confer Satisfaction Survey

IC 235441 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⚠️ Notice: This information collection may be referencing outdated material.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 0917-0036-86 Confer Satisfaction Survey	Form
0917-0036-86 Confer Satisfaction Survey Confer Satisfaction Survey_Draft_2018_1213.docx	Form
IHS Tribal Confer Satisfaction.doc IHS Tribal Confer Satisfaction	IC Document

IC Title:

Confer Satisfaction Survey

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

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	0917-0036-86	Confer Satisfaction Survey	Confer Satisfaction Survey_Draft_2018_1213.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 41

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	41	41
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
IHS Tribal Confer Satisfaction	IHS Tribal Confer Satisfaction.doc	03/21/2019

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