Information Collection

IHS Chinle Service Unit Customer Experience Survey

IC 236418 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 0917-0036 IHS Chinle Service Unit Customer Experience Survey Form and Instruction
0917-0036 Community Nutrition Updated Community Nutrition Gardening Survey 2019.docx Form and Instruction
0917-0036 Gardening Survey CN updated Gardening Survey protocol 5.29.19.docx Form and Instruction
Public Health Clearance Submission for Clinical and Community Nutrition 5.29.19.docx IHS Chinle Service Unit Customer Experience Survey. IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	IHS Chinle Service Unit Customer Experience Survey	Agency IC Tracking Number:	58

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0917-0036	Community Nutrition	Updated Community Nutrition Gardening Survey 2019.docx		No		Paper Only
Form and Instruction	0917-0036	Gardening Survey	CN updated Gardening Survey protocol 5.29.19.docx		No		Paper Only

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: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,800	1,800
Annual IC Time Burden (Hours)	90	90
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
IHS Chinle Service Unit Customer Experience Survey.	Public Health Clearance Submission for Clinical and Community Nutrition 5.29.19.docx	06/10/2019

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