View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View Generic ICR - OIRA Conclusion
OMB Control No:
0917-0036
ICR Reference No:
201205-0917-002
Status:
Historical Active
Previous ICR Reference No:
201201-0917-001
Agency/Subagency:
HHS/IHS
Agency Tracking No:
Title:
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
05/25/2012
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/18/2012
Terms of Clearance:
OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
05/31/2015
36 Months From Approved
Responses
3,030
0
0
Time Burden (Hours)
1,030
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
This fast track generic collection of infomration is neccesssary to enable IHS to garner customer and stakeholder feedback in an efficient, timely manner, in accordance with our commitment to improving service delivery. The information collected from our customers and stakeholders will help ensure that users have an effective, efficeint, and satisfying experience with the Agency's programs.
Authorizing Statute(s):
US Code:
44 USC 3501
Name of Law: Paperwork Reduction Act
EO: EO 12682 Name/Subject of EO: "Setting Customer Service Standards"
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
75 FR 80542
12/22/2010
30-day Notice:
Federal Register Citation:
Citation Date:
77 FR 1607
01/10/2012
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
15
IC Title
Form No.
Form Name
Classroom Post Class Survey
0917-0036-05
OMB Form No. 0917-05, FY_ Classroom Post Class Survey
Employee Assessment, Clinton Service Unit, IMPRESS
0917-0036-10
0917-0036-10 Employee Assessment
IHS Community Health Representative Basic Training & Refresher Training
0917-0036-15
OMB Form No., 0917-0036-15, IHS community Health Representative (CHR) Basic and Refresher Training
IHS Website Customer Service Satisfaction Survey - EHR Survey
0917-0036-03
Indian Health Service (IHS) Website Customer Service Satisfaction Survey - EHR Survey Monkey - CLASS
Indian Health Service Website Customer Service Satisfaction Survey
0917-0036-01
IHS Website Customer Satisfaction Survey Questions
OIT Customer Satisfaction Survey - Problem Ticket
0917-0036-14
OIT Customer Satisfaction Survey - Problem Ticket, OMB No. 0917-0036-14
OIT Customer Satisfaction Survey - Service Ticket
0917-0036-13
OIT Customer Satisfaction Survey-Service Ticket, OMB Form No. 0917-0036-13
Patient Assessment, Clinton Service Unit, IMPRESS
0917-0036-11
OMB No. 0917-0036-11, Patient Assessment
Physician/Dentist Customer Service Questionairre
0917-0036-12
OMB No. 0917-0036-12, Physician & Dental Customer Service Questionnaire
Satellite Classroom Post Class Survey
0917-0036-07
OMB Form No. 0917-0036-07 FY_Satellite Classroom Post Class Survey
Website Customer Service Satisfaction Survey
0917-0036-002
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery: Indian Health Service (IHS) Website Customer Service Satisfaction Survey
Website Customer Service Satisfaction Survey - EHR
0917-0036-04
IHS Customer Satisfaction Survey; EHR Survey Monkey - VIRTUAL
eLearning Post Class Survey
0917-0036-06
OMB Form No. 0917-0036-06, FY_ e Learning Post Class Survey
iCare - CMET Post Course Survey
0917-0036-08
OMB Form No. 0917-0036-08, iCare-CMET Post Course Survey
iCare Nuts and Bolts Post Class Survey
0917-0036-09
OMB Form No. 0917-0036-09, iCare Nuts and Bolts Post Class Survey
ICR Summary of Burden
Total Approved
Previously Approved
Change Due to New Statute
Change Due to Agency Discretion
Change Due to Adjustment in Estimate
Change Due to Potential Violation of the PRA
Annual Number of Responses
3,030
0
0
3,030
0
0
Annual Time Burden (Hours)
1,030
0
0
1,030
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
This is a new collection - so there is an increase in burden.
Annual Cost to Federal Government:
$15,000
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
No
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
No
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Tamara Clay 301 443-4750 Tamara.Clay@ihs.gov
Common Form ICR:
No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(a) It is necessary for the proper performance of agency functions;
(b) It avoids unnecessary duplication;
(c) It reduces burden on small entities;
(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;
(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;
(f) It indicates the retention periods for recordkeeping requirements;
(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.
(i) It uses effective and efficient statistical survey methodology (if applicable); and
(j) It makes appropriate use of information technology.
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Certification Date:
05/18/2012
An official website of the United States government
The .gov means it's official.
The site is secure.
