Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Catawba Service Unit Patient Satisfaction Survey New 360 30 0 Form and Instruction 0917-0036 Catawaba Service Unit Patient Satisfaction Survey
Community Health Representatives (CHR) National Education Training (NET) New 325 43 0 Form and Instruction 0917-0036-17 OMB No. 0917-0036-17, IHS CHR NET Plenary Eval Form
Community Health Representatives (CHR) Online Diabetes Training Evaluation New 110 9 0 Form and Instruction OMB No. 0917-0036-16 OMB No. 0917-0036-16, IHS CHR Online Diabetes Training Evaluation Form
Dental Patient Satisfaction Survey New 420 21 0 Form and Instruction 0917-0036-34 0917-0036-34, Dental Patient Satisfaction Survey
EHR Pharmacy Residence Informaticists Survey New 34 3 0 Form and Instruction OMB 0917-0036-0031 OMB 0917-0036-0031, EHR Pharmacy Resident Informaticist Survey
Gallup Service Unit Patient Satisfaction Survey New 2800 233 0 Form and Instruction 0917-0036-38 OMB No. 0917-0036-38, Gallup Service Unit Patient Satisfaction Survey
IHS Clinical Rounds Qualitative Feedback New 500 83 0 Form and Instruction 0917-0036-18 0917-0036-18, IHS Clinical Rounds Qualitative Feedback Form
IHS OEHE Customer Satisfaction Survey New 1800 90 0 Form and Instruction 0917-0036-20 0917-0036-20, Post Construction O & M Survey
Form and Instruction 0917-0036-20 0917-0036-20, Annual Operator O & M Survey
Form and Instruction 0917-0036-20 0917-0036-20, Tribal Homeowner Survey
Form and Instruction 0917-0036-20 0917-0036-20, Tribal Partner Survey
IHS Pharmacy Automation Survey 2013 New 200 33 0 Form and Instruction OMB No. 0917-0036-19 OMB No. 0917-0036-19, IHS Pharmacy Automation Survey
IHS Website ICD-10 Stakeholder Readiness Survey - ICD-10 Project Needs Assessment New 500 83 0 Form and Instruction 0917-0036-27 OMB No. 0917-0036-27, IHS Website ICD-10 Stakeholder Readiness Survey - ICD-10 Project Needs Assessment
Indian Health Service (IHS) Patient Experience Survey New 480 40 0 Form and Instruction OMB No. 0917-0036-24 OMB No. 0917-0036-24, IPC Patient Experience Survey
OMB No. 0917-0036 Indian Health Service (IHS) Wind River Service Unit (WRSU) Customer Satisfaction Survey New 1800 150 0 Form and Instruction 0917-0036 Coordinated Care Survey
Form and Instruction 0917-0036 Patient Registration Survey
Form and Instruction 0917-0036 Patient Wellness Survey
OMB No. 0917-0036 – Clinical Decision Support Usability Assessment New 400 33 0 Form and Instruction OMB No. 0917-0036 Clinical Decision Support Usabibility Assessment - Local Clinical Reminders
OMB No. 0917-0036, Indian Health Service (IHS) RPMS Stakeholder Survey – Resource and Patient Management System Program Operational Analysis Needs Assessment New 500 83 0 Form and Instruction 0917-0036 OMB No. 0917-0036, Indian Health Service (IHS) RPMS Stakeholder Survey – Resource and Patient Management System Program Operational Analysis Needs Assessment
OMB No. 0917-0036, Sugar Shockers Health Campaign Survey, Catawba Service Unit New 200 17 0 Form and Instruction 0917-0036 Sugar Shockers Health Campaign Survey, at Catawaba, SU
OMB No. 0917-0036, We Care Survey, Blackfeet Community Hospital New 1200 100 0 Form and Instruction OMB No. 0917-0036 We Care Survey, Blackfeet Community Hospital
Patient Flow Time Study New 540 45 0 Form and Instruction 0917-0036-33 Patient Flow Time Study
Patient Satisfaction Survey, Alburquerque Service Unit New 600 20 0 Form and Instruction 0917-0036-36 OMB No. 0917-0036-36, Patient Satisfaction Survey, Albuquerque Service Unit
Patient Satisfaction Survey, Crow Service Unit New 720 60 0 Form and Instruction 0917-0036 Patient Satisfaction Survey, Crow Service Unit
Patient Satisfaction Survey, Tohatchi New 360 30 0 Form and Instruction 0917-0036 OMB No. 0917-0036-39, Patient Satisfaction Survey, Tohatchi
Patient Satisfaction Survey, at CRHC New 540 45 0 Form and Instruction 0917-0036-32 Patient Satisfaction Survey, at Cheyenne River Health Center
Portland Area Division of Environmental Health Services: Customer Service Assessment New 60 15 0 Form and Instruction 0917-0036-21 OMB No 0917-0036-21, Portland Area Division of Environmental Health Services: Customer Services Assessment
Providers - e-RX Deployment New 300 25 0 Form and Instruction OMB No. 0917-0036-35 OMB No. 0917-0036-35, Providers - eRX Deployment
RPMS Annual Training Needs Assessment New 550 92 0 Form and Instruction 0917-0036-23 OMB No. 0917-0036-23, IHS RPMS Annual Training Needs Assessment
RPMS Computer Based Post Class Survey New 2500 208 0 Form and Instruction 0917-0036-28 0917-0036-28, Computer Training Post Class Survey
RPMS eLearning Hands-on Customer Satisfaction Survey New 2500 208 0 Form and Instruction OMB No. 0917-0036-30 OMB No. 0917-0036-30, RPMS eLearning Hands-on Customer Satisfaction Survey
THC Dental Patient Satisfaction Survey New 360 30 0 Form and Instruction 0917-0036 THC Dental Patient Satisfaction Survey
User satisfaction data collection for the IHS OIT NDW New 487 81 0 Form and Instruction 0917-0036 Indian Health Service, Office of Information Technology, National Patient Reporting System National Data Warehouse Data Collection Survey
VPN User Survey New 220 18 0 Form and Instruction OMB No. 0917-0036-22 OMB Form No. 0917-0036-22, IHS VPN User Survey
We Care Survey, Fort Peck SU IHS New 1800 90 0 Form and Instruction OMB 0917-0036 We Care Survey, Fort Peck SU IHS
We Care Survey, Northern Cheyenne New 720 60 0 Form and Instruction 0917-0036 We Care Patient Satisfaction Survey for Nothern Cheyenne
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 23886 2078 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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