Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Adult Care Unit (ACU) Patient Experience Survey, Chinle Service Unit (CSU) New 1200 120 0 Form and Instruction 0917-0036
Catawba Service Unit Patient Satisfaction Survey New 360 30 0 Form and Instruction 0917-0036
Chinle Service Unit (CSU) Employee Satisfaction Survey. New 2400 240 0 Form and Instruction 0917-0036
Chinle Service Unit (CSU) Health Promotion/Disease Prevention New 2400 120 0 Form and Instruction 0917-0036-58-3
Clinical Decision Support Usability Assessment New 400 33 0 Form and Instruction 0917-0036
Computer Based Post Class Survey New 2500 208 0 Form and Instruction 0917-0036
EHR Pharmacy Residence Informaticists Survey New 34 3 0 Form and Instruction 0917-0036
Employee Assessment- Clinton Service Unit - IMPRESS New 500 42 0 Form and Instruction 0917-0036
Evaluation Survey of IHS Mandatory Pain and Opioid Training and Prescriber Habits New 125 21 0 Form and Instruction 0917-0036
Fort Washakie Medical Home Patient Feedback New 200 33 0 Form and Instruction 0917-0036
Gallup Service Unit Patient Satisfaction Survey New 2800 233 0 Form and Instruction 0917-0036
IHS CHR NET Plenary Evaluation Form New 325 27 0 Form and Instruction 0917-0036
IHS Chinle Service Unit Customer Experience Survey – Clinical and Community Nutrition New 1800 90 0 Form 0917-0036
Form 0917-0036
IHS Community Health Representative Basic Training & Refresher Course Training form New 180 15 0 Form and Instruction 0917-0036
IHS OEHE Customer Satisfaction Forms New 1800 90 0 Form and Instruction 0917-0036
Form and Instruction 0917-0036
Form and Instruction 0917-0036
Form and Instruction 0917-0036
IHS Patient Experience Survey New 40 3 0 Form and Instruction 0917-0036
IHS Pharmacy Automation 2015 Survey New 200 33 0 Form and Instruction 0917-0036
IHS RPMS Annual Training Needs Assessment Survey New 550 92 0 Form and Instruction 0917-0036
IHS RPMS Stakeholder Survey – Resource and Patient Management System Program Operational Analysis Needs Assessment New 500 83 0 Form and Instruction 0917-0036
IHS Training Needs Survey New 950 238 0 Form and Instruction 0917-0036-23
IHS Web Services Customer Satisfaction Survey New 600 49 0 Form IHS Web Services Customer Feedback
IHS Website Customer Satisfaction Survey – EHR Survey Monkey – Classroom Form New 500 83 0 Form and Instruction 0917-0036
IHS Website Customer Satisfaction Survey – EHR Survey Monkey – VIRTUAL New 500 83 0 Form and Instruction 0917-0036
IHS Website ICD-10 Stakeholder Readiness Survey – ICD-10 Project Needs Assessment New 2000 333 0 Form and Instruction 0917-0036
IHS White Earth Hand Washing Survey New 500 25 0 Form and Instruction 0917-0036
Indian Health Service (IHS Website Feedback Form New 500 125 0 Form and Instruction 0917-0036
Form and Instruction 0917-0036
Indian Health Service (IHS) Clinical Rounds Qualitative Feedback New 500 83 0 Form and Instruction 0917-0036
Indian Health Service (IHS) Community Health Representatives (CHR) Diabetes Online Training Evaluation New 110 9 0 Form and Instruction 0917-0036
Indian Health Service (IHS) FY_ Classroom Post Class Survey New 1000 83 0 Form and Instruction 0917-0036
Indian Health Service (IHS) FY_ Satellite Classroom Post Class Survey New 500 42 0 Form and Instruction 0917-0036
Form and Instruction 0917-0036
Indian Health Service (IHS) FY_ eLearning Post Class Survey New 2500 208 0 Form and Instruction 0917-0036
Indian Health Service (IHS) Wind River Service Unit (WRSU) Customer Satisfaction Survey New 1800 150 0 Form and Instruction 0917-0036
Form and Instruction 0917-0036
Form and Instruction 0917-0036
Innovative Session Partnership Conference New 90 2 0 Other-Discussion Questions
OIT Customer Satisfaction Survey – Problem Ticket New 500 42 0 Form and Instruction 0917-0036
Form and Instruction 0917-0036
OIT Customer Satisfaction Survey-Service Ticket New 500 42 0 Form and Instruction 0917-0036
Form and Instruction 0917-0036
OMB Form No. 0917-0036, Indian Health Service (IHS) Community Health Representative (CHR) Basic Online Training Evaluation New 300 25 0 Form and Instruction 0917-0036
OMB Form No. 0917-0036: IHS Chinle Service Unit Customer Experience Survey, Division of Public Health. New 16200 810 0 Form and Instruction 0917-0036
Form and Instruction 0917-0036
Form and Instruction 0917-0036
Form and Instruction 0917-0036
Form and Instruction 0917-0036
Form and Instruction 0917-0036
Form and Instruction 0917-0036
Form and Instruction 0917-0036
Obstetric Care Unit (OCU) Patient Experience Survey, Chinle Service Unit New 480 48 0 Form and Instruction 0917-0036
PT/OT (Therapy Department) - Provision of Care Survey New 350 18 0 Form and Instruction 0917-0036
Patient Assessment –Clinton Service Unit - IMPRESS New 500 42 0 Form and Instruction 0917-0036
Patient Experience of Care Survey Pilot Project New 4000 467 0 Form and Instruction 0917-0036
Patient Flow Time Study New 540 45 0 Form and Instruction 0917-0036
Patient Satisfaction Survey, Alburquerque Service Unit New 600 20 0 Form and Instruction 0917-0036
Patient Satisfaction Survey, Crow Service Unit New 720 60 0 Form and Instruction 0917-0036
Patient Satisfaction Survey, Optometry Dept. White Earth Service Unit Indian Health Service New 200 10 0 Form and Instruction 0917-0036-12
Patient Satisfaction Survey, Tohatchi New 360 30 0 Form and Instruction 0917-0036
Patient Satisfaction Survey, at Cheyenne River Health Center (CRHC) New 540 45 0 Form and Instruction 0917-0036
Pediatric Care Unit (PCU) Patient Experience Survey, Chinle Service Unit (CSU) New 420 42 0 Form and Instruction 0917-0036
Physician/Dentist Customer Service Questionnaire New 500 42 0 Form and Instruction 0917-0036
Portland Area Division of Environment Health Services: Customer Service Assessment. New 60 15 0 Form and Instruction 0917-0036
Providers –e-RX Deployment Survey New 300 25 0 Form and Instruction 0917-0036
Public Health Nursing Data Mart Survey New 123 21 0 Form and Instruction 0917-0036
Special Care Unit (SCU) Patient Experience Survey, Chinle Service Unit New 360 36 0 Form and Instruction 0917-0036
Sugar Shockers Health Campaign Survey, Catawba Service Unit New 200 17 0 Form and Instruction 0917-0036
THC Dental Patient Satisfaction Survey New 360 30 0 Form and Instruction 0917-0036
Telebehavioral Health Patient Satisfaction Survey New 40 3 0 Form 0917-0036
User satisfaction data collection for the IHS OIT NDW New 487 81 0 Form and Instruction 0917-0036
VPN User Survey New 220 18 0 Form and Instruction 0917-0036
We Care Survey, Blackfeet Community Hospital. New 1200 100 0 Form and Instruction 0917-0036
We Care Survey, Fort Peck Service Unit Indian Health Service New 1800 90 0 Form and Instruction 0917-0036
We Care Survey, Fort Peck Service Unit Indian Health Service New 1800 90 0 Form and Instruction 0917-0036
We Care Survey, Northern Cheyenne New 720 60 0 Form and Instruction 0917-0036
WebTMA Survey New 75 13 0 Form and Instruction 0917-0036
White Earth Dental Clinic Patient Satisfaction Survey New 420 21 0 Form and Instruction 0917-0036
eLearning Hands-on Customer Satisfaction Survey New 2500 208 0 Form and Instruction 0917-0036
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 67739 5645 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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