Information Collection

Indian Health Service National Health Coaching Pilot Project Registration

IC 250384 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⚠️ Notice: This information collection may be referencing outdated material.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 Indian Health Service National Health Coaching Pilot Project Registration	Form and Instruction
0917-0036 HCW Application HWC Web Content questions 11.16.21 final.docx	Form and Instruction
0917-0036 HCW Application HWC Web Content questions 11.16.21 final.docx	Form and Instruction
DCCS-NHCPP Registration Clearance Submission Request-IHS 11.16.21 final.docx Submission Template HWC	IC Document
DCCS-NHCPP Registration Clearance Submission Request-IHS 11.16.21 final.docx Submission Template HWC	IC Document

IC Title:

Indian Health Service National Health Coaching Pilot Project Registration

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	HCW Application	HWC Web Content questions 11.16.21 final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Submission Template HWC	DCCS-NHCPP Registration Clearance Submission Request-IHS 11.16.21 final.docx	11/17/2021

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