View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	IHS Chinle Service Unit Customer Experience Survey – Clinical and Community Nutrition	Agency IC Tracking Number:	58

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	0917-0036	Community Nutrition Gardening Survey	2017 Community Nutrition Gardening survey new.docx		No		Paper Only
Form	0917-0036	RDN Services Survey	2017 RDN ServicesSurvey.docx		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,800	Number of Respondents for Small Entity: 1

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	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	1,800	0	0	0	0	1,800
Annual IC Time Burden (Hours)	90	0	0	0	0	90
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
RDN protocol worksheet	RDNSurveyProtocol Worksheet.2017.docx	04/13/2017
CN Gardening Survey protocol	CN Gardening Survey protocol.docx	04/13/2017
Public Health Clearance Submission for clinical and community nutrition	Public Health Clearance Submission for Clinical and Community Nutrition 3.2.17.docx	04/13/2017

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