Information Collection

Indian Health Service Statement of Health

IC 261336 under ICR 202307-0917-001 · OMB 0917-0009.

Documents and Forms

Document Name Document Type
Form 0917-0009 Indian Health Service Statement of Health Form and Instruction
0917-0009 Statement of Health IHS Statement of Health.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents:	Number of Respondents for Small Entity:

Affected Public:

Percentage of Respondents Reporting Electronically:

		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
Annual IC Time Burden (Hours)
Annual IC Cost Burden (Dollars)

Documents for IC

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