OMB control number
Indian Affairs Public Health Needs Assessment
OMB 1076-0200 ยท DOI/BIA.
OMB 1076-0200
Enhancing the public health and safety capacity throughout Indian Affairs is a force multiplier in achieving the goals of our agency and in meeting the Occupational Safety and Health Act of 1970, Section 5 directive to create a place of employment free from recognized hazards. The purpose of this survey is to identify and prioritize public health issues and needs and enhance the public health and safety capacity throughout Indian country. The Office of Facilities, Property and Safety Management (OFPSM) Public Health and Safety (PHS) Team will use survey results to develop and coordinate action plans.
The latest form for Indian Affairs Public Health Needs Assessment expires 2026-08-31 and is listed under ICR 202210-1076-002.
Latest Forms, Documents, and Supporting Material
| Document | Type |
|---|---|
 Indian Affairs Public Health Needs Assessment Survey | Form and Instruction |
| Indian Affairs Public Health Needs Assessment Survey | Form and Instruction |
| 90 FR 45405.pdf | Supplementary Document |
| 90 FR 24288.pdf | Supplementary Document |
 IAFR001470__SSB_Public Health Needs Assessment.docx | Supporting Statement B |
| IAFR001470__SSA_Public Health Needs Assessment.docx | Supporting Statement A |
| Occupational Safety and Health Act of 1970 (PL).pdf | Supplementary Document |
| Occupational Safety and Health Act of 1970 (USC).pdf | Supplementary Document |
 Survey (Individuals) |
Form and Instruction |
| Survey (State, Local, Tribal Governments) |
Form and Instruction |
All Historical Document Collections
| Reference | Filing | Received | Concluded | Action |
|---|---|---|---|---|
| 202505-1076-001 | Extension without change of a currently approved collection | 2025-09-23 | ||
| 202210-1076-002 | New collection (Request for a new OMB Control Number) | 2023-01-11 | Approved without change |
OMB Details
Survey (State, Local, Tribal Governments)
Federal Enterprise Architecture: Health - Public Health Monitoring
| Form | Name | Electronic access | Type |
|---|---|---|---|
| Form N/A | Indian Affairs Public Health Needs Assessment Survey | Fillable Fileable | Form and instruction |
Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.