Information Collection

2024 Health IT Modernization Tribal Consultation/Urban Confer Satisfaction Survey

IC 266293 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⚠️ Notice: This information collection may be referencing outdated material.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 2024 Health IT Modernization Tribal Consultation/Urban Confer Satisfaction Survey 2024 Health IT Modernization Tribal Consultation/Urban Confer Satisfaction Survey	Form and Instruction
0917-0036 2024 Health IT Modernization Tribal Consultation/Urban C 2024 TCUC Survey DHITMO.docx	Form and Instruction
2024 TCUC Survey Submission Form.DHITMO.docx 2024 Health IT Modernization Tribal Consultation/Urban Confer submission	IC Document

IC Title:

2024 Health IT Modernization Tribal Consultation/Urban 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 and Instruction	0917-0036				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	65	65
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
2024 Health IT Modernization Tribal Consultation/Urban Confer submission		03/25/2024

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

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