Chapter 24 - Forms
Part 5 - Management Services
Exhibit | Description |
---|---|
Manual Exhibit 5-24-A | "HHS Request for Form Action" |
Manual Exhibit 5-24-B | "Indian Health Service - National Supply Service Center" |
- Purpose. The purpose of this chapter is to establish the Indian Health Service (IHS) policy, procedures, responsibilities, and operating instructions for the control of IHS forms.
- Authority. This chapter is based upon the following:
- 5 United States Code (U.S.C.) Chapter 5, Sec. 552a, "Records Maintained on Individuals"
- 44 U.S.C. Chapter 31, "Records Management by Federal Agencies"
- 44 U.S.C. Chapter 35, "Coordination of Federal Information Policy"
- 41 Code of Federal Regulations (CFR) 102-193 Federal Records
- 41 CFR 102-194 Standard and Optional Forms
- Office of Management and Budget (OMB) Circular A-130, "Management of Federal Information Resources"
- Department of Health, Education, and Welfare, Transmittal Notice-75.1, (12/01/75), "Forms Management"
- Delegation of Authority for Ordering, Printing, and Distributing IHS Forms - Administrative #41
- OMB Circular A-108, "Privacy Act Implementation"
- Background. Completed forms play a vital role in gathering information to provide health services. Forms document essential transactions that need to be preserved to protect the legal and financial rights of the Government and the people directly affected by the Agency's activities. Forms may become a major expense item if their use is not controlled and there is a lack of uniformity among consumers. Major expenses incurred during forms development and use may include printing, procurement, administrative, clerical, and machine costs.
- Policy. The IHS will provide efficient, economical, and effective management of the creation, use, and disposition of all IHS forms by:
- centralizing the control of the creation, revision, and numbering of IHS forms;
- ensuring IHS forms are designed to increase their usefulness in collecting, storing, disseminating, or using information; and
- ensuring Area Offices and service units are not creating and/or issuing nonstandard forms.
- Objectives. The IHS Forms Management Program (FMP) will:
- provide centralized control in the creation, revision, and numbering of IHS forms;
- design forms that are easy to understand, complete, transmit, process, and retrieve;
- reduce production costs associated with forms;
- create forms that collect information efficiently;
- create forms that collect essential information only;
- ensure that existing forms are reviewed annually to determine if they can be improved or canceled; and
- ensure forms comply with the legislation and regulations regarding individual and Privacy Act use.
- Headquarters.
- Director, IHS. The Director, IHS, is responsible for ensuring that an Agency FMP is established and implemented.
- Director, Office of Management Support. The Director, Office of Management Support (OMS), assures the Director, IHS, that the IHS FMP operating efficiently and effectively. The Director, OMS, ensures that FMP is conducted in accordance with applicable laws and regulations Part 5, Chapter 16, "Management Control Systems," Indian Health Manual (IHM), and that it is achieving the intended results.
- Director, Division of Administrative Support. The Director, Division of Administrative Support (DAS), OMS, is responsible for overseeing the IHS FMP. The Director, DAS, appoints the Forms Management Officer (FMO).
- Forms Management Officer. The IHS FMO is responsible for administering and directing a comprehensive IHS-wide forms management program as follows:
- Develops and implements IHS-wide policy and procedures to establish continuous and systematic control of the creation and discontinuation of IHS forms.
- Plans, develops, administers, and evaluates all IHS forms (paper and electronic) issued for use by the IHS.
- Advises and assists IHS officials, program managers, first-line supervisors, employees, and contractors regarding forms management.
- Establishes an IHS forms catalog and ensures the accuracy of the information contained therein. This includes maintaining the downloadable forms section of the IHS Internet and Intranet sites.
- Informs the Areas and the IHS National Supply Service Center (NSSC) of all new, revised, and/or discontinued IHS forms. (See Manual Exhibit 2004-24-B.)
- Provides forms management technical support to Headquarters, Area Offices, service units, health centers, Urban Indian Health Programs, and Tribal contract/compact organizations as requested. Technical support activities include providing guidance in the design of new forms or improving current forms, assisting in obtaining printing services, obtaining necessary clearances, and meeting all other forms-management requirements.
- Maintains a complete history of each IHS form in accordance with Department of Health and Human Services (HHS) regulations.
- Coordinates OMB clearance requirements for IHS forms with the IHS OMB Clearance Officer.
- Ensures that forms subject to the Privacy Act of 1974 are identified and cleared by the IHS Privacy Act Officer.
- Participates as a member of the IHS Patient Care Forms Committee.
- Acts as the IHS liaison to other agencies and organizations on all forms management-related activities.
- Deputy Director, Office of Public Health. The Deputy Director, Office of Public Health (OPH), or designee, is responsible for establishing the IHS Patient Care Forms Committee. Committee members include:
- Chairperson: Deputy Director, OPH
- Privacy Act Officer
- Health Records Consultant
- IHS FMO
- IHS Records Management Officer
- Indian Health Service Patient Care Forms Committee. The IHS Patient Care Forms Committee shall perform the following activities:
- Review proposed drafts of new or revised IHS forms and/or proposed request for discontinuation of IHS forms from Headquarters and Area disciplines
- Determine needs, appropriateness, format, and design of new or revised IHS forms. If necessary, the committee shall modify the form.
- Approve or disapprove all requests for new IHS forms or the revision of existing forms.
- Medical Consultants Review Team.
- Purpose. The purpose of the Medical Consultants Review Team (MCRT) is to review the contents of new or revised IHS patient care forms for adequate documentation of the medical care provided by the IHS health care system.
- Team Members. The MCRT is composed of 10 members drawn from the Area Patient Care Forms Committee(s).
- Responsibility. The team members are responsible for reviewing the contents of new or revised IHS patient care forms. This may include consulting with local medical care experts for appropriateness. Members report to the IHS FMO with their findings and recommendations.
- Area Offices.
- Area Directors. Each Area Director shall implement and operate a forms management program in conformance with Part 5, Chapter 24, IHM. The Area Director will:
- designate in writing an Area Forms Manager (AFM) to manage the Area FMP,
- submit a designation memorandum identifying the AFM and Service Unit Forms Management Liaison (SUFML) to the IHS FMO whenever there is a change, and
- ensure the Area has an active interdisciplinary Patient Care Forms Committee.
- Area Forms Manager. The AFM provides assistance to program officials on forms management activities and provides administrative support and advice as needed to maintain program activities. The AFM performs the following activities:
- Implements the procedures outlined in this chapter.
- Serves as the liaison between Headquarters and Area Offices to:
- process all new proposed IHS forms,
- make recommendations to revise existing IHS forms, and
- make recommendations to discontinue an IHS form.
- Ensures that all service units, health centers, Urban Indian Health Programs, and Tribal contract/compact organizations have access to the latest edition of the IHS forms catalog for use.
- Serves as the contact person for all IHS forms activities within the Area. Activities include providing assistance in procuring forms, evaluating health facilities to ensure that adequate stock of forms are on hand, and providing technical assistance in the life cycle of IHS forms.
- Works with the established Area Patient Care Forms Committee in the processing of all new, revised, or discontinued patient-care forms.
- Provides forms management advice and assistance to Tribal contract/compact organizations upon request.
- Endures the Area has an established forms network consisting of designated forms-management liaisons from all health facilities.
- Area Chief Medical Officer. The Area Chief Medical Officer, or designee, is responsible for establishing the Area Patient Care Forms Committee and serves as the committee's chairperson. Area Patient Care Forms Committee members are the:
- Chairperson: Area Chief Medical Officer or designee
- Area Freedom of Information Act Coordinator
- Area Privacy Act Advocates
- Area Medical Records Consultant
- Area Forms Manager
- Area Patient Care Forms Committee. The Area Patient Care Forms Committee shall:
- review proposed drafts of new or revised IHS forms;
- reject or refer request to specific disciplines for further review, comment, or development;
- determine the request's impact for use based on the need, appropriateness, format, and design; and
- approve or disapprove all temporary forms initiated by the Area Office and/or service units.
- Area Directors. Each Area Director shall implement and operate a forms management program in conformance with Part 5, Chapter 24, IHM. The Area Director will:
- Service Unit.
- Service Unit Director/Chief Executive Officer. Each Service Unit Director (SUD)/Chief Executive Officer (CEO) is responsible for establishing an effective forms management program. The SUD/CEO will:
- designate in writing a SUFML, who will implement the IHS FMP guidelines; and
- submit a designation memorandum identifying the SUFML to the AFM whenever there is a change.
- Service Unit Forms Management Liaison. Each SUFML is responsible for:
- providing technical assistance in forms management by recommending or supplying information to offices about forms;
- forwarding recommended new or revised forms to the appropriate AFM;
- determining the need of forms to ensure the health facility has adequate stock levels to last at least 1 month to avoid emergency situations; and
- coordinating the ordering and/or distribution of IHS forms for the health facility.
- Service Unit Director/Chief Executive Officer. Each Service Unit Director (SUD)/Chief Executive Officer (CEO) is responsible for establishing an effective forms management program. The SUD/CEO will:
- Originating Office. The originating office must communicate orally or in writing with the Area FMO prior to beginning work designing a new or revising an existing form.
- Format Standards. All new or revised IHS forms will have the following attributes:
- Collect information efficiently. All IHS programs will ensure that new or revised forms can be completed with minimum effort by employees and/or the public.
- Collect only essential information. All IHS programs shall evaluate whether the information being requested may be obtained from other sources.
- Form Title. Each new or revised IHS form will have a title that concisely describes the function or purpose of the form. Using the location name as part of the title is not authorized.
- Control Number. Each new or revised IHS form will be assigned a control number. The IHS FMO is the only person authorized to assign this number. The number will be located in the upper right comer of the form.
- Form Date. Each new or revised IHS form must be identified by the month and year in which it originated or is revised. The date will be located immediately below the form's control number.
- Logos, Designs, or Decorative Artwork. The use of IHS seals, logos, designs, or decorative artwork is not authorized on any IHS form.
- Quality Control.
- Extensive reviews will be conducted at all levels prior to the finalization of any official IHS forms due to the variation and uniqueness of certain programs and the multiple uses of forms by health practitioners and administrative personnel.
- The Patient Care Forms Comrnittee(s) must evaluate each IHS form to ensure that program standards and requirements are met.
- Duplication of Forms.
- General Services Administration Standard Forms. The IHS programs will not duplicate General Services Administration (GSA) Standard Forms for the sole convenience of personal preference or to number the form with the IHS forms control numbering system. The GSA Standard Forms are prescribed by Federal agencies through regulations and approved by GSA for mandatory use. All IHS offices are required to use GSA Standard Forms for all administrative or medical information collections if such forms exist for IHS purposes.
- Departmental Forms. The IHS programs may not duplicate HHS forms for the sole convenience of personal preference or to number the form with the IHS forms control numbering system. As an Agency of HHS, the IHS is required to use HHS forms if the form meets IHS program requirements.
- Indian Health Service Forms. The IHS programs may not duplicate existing IHS forms for the sole convenience of personal preference, such as having the Area or health facility name printed on the form.
- Overprinting. Overprinting means the printing of pertinent identical entries (e.g., facility address, accounting codes and organization codes) in a captioned area on a form. Overprinting does not include changing the content of a form. The IHS does allow facilities to overprint certain patient care and administrative forms. The overprinting of forms must be coordinated with the AFM to ensure the availability of funds.
- Temporary Forms.
- Non-automated proposed or revised IHS patient care forms may be used at the service unit on a trial basis before being forwarded to the IHS FMO for formal action.
- Each Area must establish a set of protocols for the service unit or health center to follow when issuing a local temporary patient care form on a trial basis.
- The AFM and the Area Patient Care Forms Committee must be part of the review process.
- The trial period will be 6 months in duration.
- Approved local temporary patient care forms will be assigned a local temporary form number using a number control system. The temporary form number shall be printed on all temporary forms.
- Approved local temporary patient care forms must have an expiration date next to the temporary form number. The expiration date is not to exceed the last day of the trial period.
- All approved local temporary patient care forms shall be reviewed at the end of the trial period for need or appropriateness.
- If the review process indicates a need for the local temporary patient care form, the Area Office or service unit will follow the procedures for new or revised forms outlined in this document in Section 6.
- If the review process indicates there is no need for the form or the form is not appropriate, all drafts and comments will be forwarded to the AFM for recordkeeping purposes. All printed forms must be physically destroyed.
- Office of Management and Budget. Office of Management and Budget (OMB) clearances must be obtained when the form requires the public collection of information from 10 or more respondents. The deciding factor in determining the necessity of an OMB clearance is whether there is Federal sponsorship in the information collection. The key determinant of Federal sponsorship is whether the Federal Government causes another person, agency, or government body to collect the information.
- Privacy Act. Privacy Act clearance will be obtained only when the form is intended for public use. Provisions of the Privacy Act require that each public use form requiring individually, identifiable, information to include the following:
- The authority which authorizes the solicitation of information.
- The principal purpose for which information is intended to be used.
- The routine use which will be made of the information.
- The effect on the individual, if any, for not providing all or any part of the request.
- Freedom of Information Act. The "Freedom of Information Act" (FOIA) is a Federal access law which allows individuals to inspect public records held by Government agencies. All IHS forms are subject to FOIA. By involving FOIA in the development and review process, IHS forms can be segmented in advance according to what is and is not releasable under FOIA.
- Accuracy. The accuracy of forms control is a vital factor in the management of forms.
- Forms Files. Headquarters, Area Offices, and service units will establish and maintain forms control files in compliance with the IHS Records Management Program policy and procedures. Forms files will be maintained and disposed of in accordance with disposition authorities from the IHS Records Disposition Schedule or the National Archives and Records Administration General Records Schedule.
- Headquarters. The following three types of form control files will be kept by the IHS FMO.
- Forms Case History File. A forms case history file is a numerical forms case history of all forms issued by the IHS. The file provides development and evaluation information through all revisions to the current status of each form.
- Functional Classification System. All HHS and GSA forms are classified under a functional classification system used to identify individual and related forms. The system may be used to evaluate, simplify, combine, or cancel existing forms. The IHS FMO will work with HHS and GSA in establishing a functional classification system to be used by the IHS. The FMO will ensure that each IHS form created will be classified according to the subject matter and action of the form.
- Forms Catalog System. The forms catalog system is a database management system that lists all approved IHS forms. The IHS FMO is responsible for keeping and updating the system to ensure that accurate information is available. The IHS FMO will ensure that the catalog is available to all Area Offices, service units, health centers, Urban Indian Health Programs, and Tribal contract/compact organizations through the issuance of paper, electronic, or Web-based copies.
- Area Office. The following four types of files will be kept by the AFM:
- Forms Correspondence File. The forms correspondence file includes correspondence and reports pertaining to the administration and operation of the Area Forms Program. The file will include site reviews conducted to evaluate health facilities' forms programs.
- Forms Inventory File. The forms inventory file documents the procurement, inventory control, and issuance of forms. The file will provide a detailed listing of active forms used by the Area Office.
- Accountable Forms File. The accountable forms file documents the control and issuance of accountable forms by the Area Office.
- Temporary Forms Case File. The temporary forms case file documents the history of the development and evaluation of each trial form issued by the Area.
- Service Unit - Forms Issue/Stock Control File. The forms issue/stock control file documents the procurement, inventory control, and issuance of forms. The file provides a detailed listing of active forms used by the service unit or health center.
- Headquarters. The following three types of form control files will be kept by the IHS FMO.
- Numerical Forms Register. The numerical forms register is used to record the assignment of control numbers to IHS forms and Area temporary/trial forms.
- The IHS FMO will maintain the register of control numbers assigned to IHS forms.
- The AFM will maintain the register of control numbers assigned to Area temporary/trial forms.
- Site Reviews. The Area Office, service unit, and health center site reviews will be conducted by the AFMs when directed by the Area Director, or when requested by a Service Unit or Health Center Director to evaluate the FMP for proper controls. Primary review elements include documenting the following:
- Forms control and records maintenance.
- Inventory control of forms.
- That facilities are not issuing non-standard forms.
- That unauthorized duplication is eliminated.
- Site Review Reports. Area Forms Managers are required to send a copy of the site review reports to the IHS FMO.
5-24.6 PROCEDURES FOR CREATING A NEW OR REVISED FORM
- Initiation of a New Form. The need to create a form arises out of a work situation where the form is necessary to gather information, to solve a specific problem, or to facilitate a procedure. The following procedures will be implemented when submitting a request for a new form or requesting a revision to an existing form.
- Area Office, Service Unit, or Health Center.
- Specific Area Office, service unit, or health center disciplines shall present in writing to the AFM the need for a new form or a revision to an existing IHS form.
- The AFM will submit the request to the Area Patient Care Forms Committee for review and approval.
- Area Office. The AFM will submit the draft request along with a completed IHS-914, "IHS Request for Form Action,"" to the IHS FMO, in Rockville, Maryland. (See Manual Exhibit 2004-24-A.)
- Headquarters.
- The Headquarters requesting office shall submit the draft form along with a completed IHS-914, "IHS Request for Form Action,"" to the IHS FMO.
- All requests received from IHS Headquarters offices, an Area Office, or a service unit/health center that is related to patient care must be reviewed by the MCRT.
- Upon completion of the MCRT review process, the proposed patient care form will be forwarded to the IHS Patient Care Forms Committee for review.
- The FMO will:
- determine if OMB clearance is necessary;
- determine if an additional review by the IHS Branch, Public Health Division, Office of General Counsel, is necessary;
- provide the final approval or denial of all IHS forms requests;
- upon approval, assign the IHS forms control number; and
- upon assignment of the forms control number, notify the originating office, all AFMs, and all supply centers of the new or revised IHS form.
- Area Office, Service Unit, or Health Center.
- Publication of the Form.
- The IHS FMO will request camera-ready copies of the new or revised IHS form.
- Upon receipt of the camera-ready copies, the IHS FMO will retain an original set and distribute the remaining copies to the NSSC.
- The NSSC will print, stock, and distribute the new or revised forms.
- The FMO will forward a copy of the form to the HHS Program Support Center (PSC) Web-site Manager for inclusion on the HHS forms download Web site.
- The FMO will forward a copy of the form to the IHS Web-site Manager for inclusion in the IHS Administrative Support forms download Web site.
- Goal. The primary goal of this section is to prevent the unwarranted accumulation of forms. Forms are a major expense item; therefore, the proper procurement, storage, and issuance of forms can help control costs.
- Usage. Each form used by the facility must be evaluated to determine the level of usage. The results will show which forms are high-usage and which are low-usage. High-usage forms shall be given first consideration for procurement. Each facility must ensure that at least a 1-month supply of forms are on hand at all times.
- Internet Sites. All facilities are encouraged to use the IHS or HHS Internet sites to download IHS, HHS, or GSA forms on an as-needed basis. This will eliminate the ordering and/or stocking of single-sheet forms.
- Photocopying. Photocopying of an official IHS patient care form is discouraged. The IHS patient care forms must be available in adequate quantities at all times.
- Storage. Facilities shall store forms in a centralized storage area. This will help facilitate in the evaluation of forms usage. Each facility must ensure that at least 1 month supply of forms are on hand at all times.
- Ordering. Forms must be ordered through the NSSC. The NSSC is authorized to print, store, and distribute large quantities of forms. All AFMs must order forms from the NSSC, which has ordering authority for the IHS. (See Manual Exhibit 5-24-B.)
- Forms Disposition. Forms disposition is action taken on forms no longer needed to conduct IHS business. The actions include removing the identified form from the catalog, notifying all health facilities of the form inactivation, and the physical disposal of the inactivated form. The primary goal of the forms disposition action is the elimination of forms as soon as they have finished serving their purpose. The procedures presented in this section have been established for the orderly disposition of all inactivated IHS forms. The procedures for recommending the discontinuation of a form are as follows:
- Specific service unit, health center, Area Office, or Headquarters disciplines shall present the recommendation in writing to the IHS FMO for the discontinuation of an IHS form.
- The requesting office must submit a written justification of why the form is no longer required and a completed IHS-914 "IHS Request for Form Action.""
- The IHS FMO will consult with the originating office that issued the form, all AFMs, and the Headquarters Patient Care Forms Committee regarding the request. A consensus from all consulted individuals must be obtained before any IHS form is discontinued.
- Area Forms Managers shall consult with each health facility under their jurisdiction regarding the proposal to discontinue an IHS form.
- When a form is discontinued, all related history files will be cut off and transferred to the appropriate records centers for retention.
- Annual Review. The IHS FMO shall be responsible for performing an annual review of each IHS form to evaluate the activity status of each form. When a form is determined to be obsolete, the IHS FMO will follow the discontinuation procedure as discussed in Section A above to cancel the obsolete form.
- Proposed Electronic Forms All electronic form proposals must be analyzed by the IHS FMO for compliance with IHS, HHS, and GSA forms-management policy and procedures. The IHS forms have been made available in electronic format on the IHS Intranet and PSC Internet sites. Their availability is mandated by the "Government Paperwork Elimination Act," Public Law 105-277, Title 17. The types of electronic forms available on the IHS Intranet and PSC Internet sites are as follows:
- Single sheet forms. Single sheet forms can be downloaded and printed for limited use. Large quantities of forms must be ordered through the NSSC.
- Multiple sheet forms. Multiple sheet forms are available for viewing only. The downloading, printing, and use of multiple sheet electronic forms is not permissible, as some forms are in multiple-colored copies. All IHS health facilities must continue to procure the paper version for use from the NSSC in Ada, Oklahoma. The prohibition will be lifted when the IHS establishes the capability of electronic submission of information.
- Forms Software Supported by the IHS. Forms are important tools in organizing, collecting, and transmitting information quickly and efficiently. Many commercial software packages are now available for automating the creation and processing of forms electronically. The IHS will only support the use of one software package to provide standards and ensure that electronic forms are properly maintained. The Chief Information Office (CIO) is authorized to set the standard for commercial software packages, and approval must be obtained prior to any purchases.
- Legacy Systems. Systems that were developed prior to this manual are exempt; however, any upgrades or new applications that include the development of electronic forms must receive prior approval. See Section 7 for new forms approval submission.
- Approved Forms Library. The IHS FMO will update and maintain the forms library for the Agency's approved forms software package. All approved electronic forms and updates to them must be submitted to the IHS FMO prior to implementation and use within the IHS.
- Approval of Forms Design Software Purchases. In order to take full advantage of future technological improvements, it is essential that the standardization of forms be maintained. The FMO will make every effort to ensure standardization throughout the Agency and to preclude the proliferation of unauthorized forms. Acquisition of other electronic forms design and mapping software is prohibited unless a request for deviation from the prescribed Agency software is submitted to and approved by the FMO and the CIO. The requesting office must understand that the FMO and CIO will not support any other software outside of the prescribed Agency software.