Information Collection

WebTMA Survey

IC 226049 under ICR 202201-0917-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 WebTMA Survey	Form and Instruction
0917-0036 WebTMA Survey SurveyMonkey IHS TMA Use.pdf	Form and Instruction
0917-0036 WebTMA Survey SurveyMonkey IHS TMA Use.pdf	Form and Instruction
TMA Survey Request Form 2017.doc WebTMA Survey Request Form	IC Document
TMA Survey Request Form 2017.doc WebTMA Survey Request Form	IC Document

IC Title:

WebTMA Survey

Agency IC Tracking Number:

IC Status: Unchanged

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 and Instruction	0917-0036	WebTMA Survey	SurveyMonkey IHS TMA Use.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 75

Number of Respondents for Small Entity: 1

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	75	75
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
WebTMA Survey Request Form	TMA Survey Request Form 2017.doc	03/13/2017

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