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OMB Form No. 0917-0036: IHS Chinle Service Unit Customer Experience Survey, Division of Public Health.

IC 218239 under ICR 202201-0917-001 · OMB 0917-0036.

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Form and Instruction
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Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
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Form and Instruction
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Information Collection (IC) Details

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OMB Form No. 0917-0036: IHS Chinle Service Unit Customer Experience Survey, Division of Public Health. 58
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0917-0036 Wellness Center Survey 0917-0036-Chinle Wellness Center Client Survey.docx Yes No Printable Only
Form and Instruction 0917-0036 Adolescent School Health 0917-0036-Adolescent and School Health Survey.docx Yes No Printable Only
Form and Instruction 0917-0036 Community Nutrition Survey 0917-0036-Community Nutrition Food Demo Survey.docx Yes No Printable Only
Form and Instruction 0917-0036 Diabetes Survey 0917-0036-Diabetes Services Survey.docx Yes No Printable Only
Form and Instruction 0917-0036 Health Promotion Survey 0917-0036-Health Promotion Survey.docx Yes No Printable Only
Form and Instruction 0917-0036 Native Medicine Survey 0917-0036-Native Medicine Survey.docx Yes No Printable Only
Form and Instruction 0917-0036 Public Health Nursing - for Patient Care Giver - Survey 0917-0036-PHN Customer Services Survey Care Giver.docx Yes No Printable Only
Form and Instruction 0917-0036 Public Health Nursing - for Patient 0917-0036-PHN Customer Services Survey.docx Yes No Printable Only

Health Health Care Services

 

16,200 0
   
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 16,200 0 0 0 0 16,200
Annual IC Time Burden (Hours) 810 0 0 0 0 810
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
OMB No. 0917-0036, Supporting Statement for IHS Chinle Service Unit Customer Experience Survey, Division of Public Health 2015 Generic Clearance Submission - Public Health Customer Satisfaction Survey with tjohnson changes 9 15 15.docx 09/17/2015
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.