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Indian Health Service The Federal Health Program for American Indians and Alaska Natives


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Part 1 - General

Chapter 1 - Indian Health Service Manual System

Title Section
Introduction 1-1.1
    Purpose 1-1.1A
    Background 1-1.1B
    Indian Health Service Manual System 1-1.1C
    Policy 1-1.1D
    Responsibilities 1-1.1E
Indian Health Manual 1-1.2
    Authority for IHM Chapters 1-1.2A
    Parts in the IHM 1-1.2B
    IHM Chapter Format 1-1.2C
Transmittal Notices 1-1.3
Delegations of Authority 1-1.4
    Original 1-1.4A
    Copies 1-1.4B
    Electronic Retrieval 1-1.4C
    Area Offices 1-1.4D
Area Supplements to the IHM 1-1.5
    Page Headers and Footers for Area Supplements 1-1.5A
    Page Footers for Area Supplements 1-1.5B
Indian Health Service Circulars 1-1.6
    Circular Format 1-1.6A
    Authority 1-1.6B
    Format for IHS Headquarters Circulars 1-1.6C
    Consolidation 1-1.6D
Area Office Circulars 1-1.7
    Title Page Headers for Area Office Circulars 1-1.7A
    Headers for the Second and Subsequent Pages 1-1.7B
Clearance of IHS Area Office Directives 1-1.8
    Distribution of Draft Area Office Directives for Review and Comment 1-1.8A
    Consideration and Use of Comments and Recommendations 1-1.8B
Special General Memorandum 1-1.9
    Authority 1-1.9A
    Format for an SGM 1-1.9B
    Control Numbers 1-1.9C
    Area Office SGMs 1-1.9D
Indian Health Service Manual System Style Guidelines 1-1.10
Directives Development Process 1-1.11
    Notification 1-1.11A
    Designation of Management Policy and Internal Control Staff Assistance 1-1.11B
    Headquarters Functional Area Managers 1-1.11C
    Contracted Directives Development 1-1.11D
    Directives Development Workgroups 1-1.11E
Clearance of IHS Directives 1-1.12
    Submission for Approval 1-1.12A
    Headquarters Review and Comment Period 1-1.12B
    Exceptions to Review and Comment Periods 1-1.12C
    Reviewers 1-1.12D
    Consideration and Use of Comments and Recommendations 1-1.12E
    Preparation of Directive Transmittal Package 1-1.12F
    Transmittal of Directive for Signature 1-1.12G
Control, Distribution, and Filing of IHS Directives 1-1.13
    IHM Chapters 1-1.13A
    IHS Headquarters Circulars 1-1.13B
    Special General Memorandum 1-1.13C
Procedures for Rescinding IHS Manual System Directives 1-1.14
    IHM Chapters 1-1.14A
    IHS Circulars 1-1.14B
    Special General Memorandum 1-1.14C


Exhibit Description
Manual Exhibit 1-1-A Example - Transmittal Notice Format
Manual Exhibit 1-1-B Example - Indian Health Manual Table of Contents Format
Manual Exhibit 1-1-C Example - Indian Health Manual Appendix/Exhibit Format
Manual Exhibit 1-1-D Example - Indian Health Service Headquarters Circular Format
Manual Exhibit 1-1-E Example - Indian Health Service Area Office Circular Format
Manual Exhibit 1-1-F Example - Circular Appendix/Exhibit Format
Manual Exhibit 1-1-G Example - Special General Memorandum
Manual Exhibit 1-1-H Example - Indian Health Service Circular Errata Notice

1-1.1  INTRODUCTION

  1. Purpose.  This chapter establishes the policy, procedures, and responsibilities for the development of Indian Health Service (IHS) directives and for the administration and maintenance of the IHS manual system.
  2. Background.  The Department of Health and Human Services (HHS) maintains a manual system that provides instruction and information to HHS employees.  The HHS manual system is the authoritative source for information on the policies, standards, and procedures that govern the administrative operations of the HHS.  The HHS manual system is composed of the HHS staff manuals and the HHS General Administration Manual (GAM).
    1. Department of Health and Human Services Staff Manuals.  Each HHS staff manual covers policies and procedures for specific subject-matter areas.  The following HHS staff manual index may be found at: http://www.hhs.gov/hhsmanuals/:

      1. Public Health Service Facilities Manual, Volume I, “Facilities Planning, Design, and Construction”
      2. Public Health Service Facilities Manual, Volume II, “Real Property Management and Facilities Services”
      3. Accounting Manual
      4. Acquisition Regulation Manual
      5. Emergency Planning Manual
      6. Forms Management Manual
      7. Frequently Asked Questions About Forms Manual
      8. Records Management Manual
      9. General Administration Manual
      10. HHS Administration Manual, Part 30, Environmental Protection
      11. Grants Administration Manual Menu
      12. Grants Policy Directives
      13. Information Resources Management Manual
      14. Logistic Manual
      15. Mail Room Procedure Manual
      16. National Security Information Manual
      17. Public Affairs Manual
      18. Safety Management Manual
      19. Travel Manual
    2. Staff Manual Subject-Matter.  All manuals of the HHS manual system except the GAM cover a specific subject-matter area and are directed to a particular group of employees (e.g., auditors, accountants, personnel specialist, secretaries, etc.).  Current manuals in the system cover these subject-matter areas:

      1. Accounting
      2. ADP Systems
      3. Correspondence
      4. Emergency
      5. Facilities Engineering
      6. Forms Management
      7. Grants Administration
      8. Material Management
      9. Organization
      10. Personnel
      11. Printing Management
      12. Procurement
      13. Public Affairs
      14. Records Management
      15. Safety Management
      16. Security
      17. Telecommunications
      18. Time and Leave
      19. Travel
      20. Voucher Examination
    3. General Administration Manual.  The HHS GAM may be found at:  http://www.hhs.gov/hhsmanuals/administration.pdf.  The HHS GAM covers administrative subject-matter areas that are not covered by the specialized HHS staff manuals.  Subjects covered by the GAM include:

      1. Committee Management
      2. Directives Management
      3. Environmental Affairs
      4. Federal Register Documents
      5. Intergovernmental Relations
      6. International Relations
      7. Legislative Matters
      8. Mail Management
      9. Legislative Affairs
      10. Patents and Inventions
      11. Privacy of Employees
      12. Reports Management
      13. Tort Claims
      14. User Charges
    4. Supplements to the HHS Manual System.  Agencies may issue supplements to the HHS manuals, and the IHS does so to include information specifically applicable to IHS administration and operations.  (Ref: HHS Department Staff Manual Administration Manual, Chapter 1-00-40G, “Supplements and New Directives.”)
    5. Supplements to the HHS Manual System Issued by the Office of the Assistant Secretary for Health.  The Office of the Assistant Secretary for Health (OASH) was abolished as an organizational entity in 1995, and each of the Public Health Service (PHS) agencies became Operating Divisions (OPDIV) within the Department.  Supplements to the HHS manual system that were issued by the OASH to interpret and apply Department-wide requirements within the PHS became inoperative, except for the following:

      1. Directives that originated in the OASH for functions that the PHS was designated as the HHS lead agency.
      2. The commissioned corps personnel manual system.
      3. Public Health Service personnel directives that are being phased into the HHS Personnel Manual.

  3. Indian Health Service Manual System.  Indian Health Service directives are issued in one of the following formats:  An Indian Health Manual (IHM) chapter, an IHS circular, an IHS Area Offices’ supplement to an IHM chapter and/or IHS circular, or a Special General Memorandum (SGM).  When higher echelon directives do not provide sufficient guidance for IHS staff, the IHS must develop and implement policies and procedures that contain adequate information to assist IHS employees in carrying out their responsibilities.
  4. Policy.  Managers at all levels in the IHS are responsible for ensuring that directives pertaining to their areas of functional responsibility are developed, reviewed, cleared, approved, and distributed in accordance with the requirements of this chapter.  Managers shall ensure that each directive is current and contains appropriate and adequate policy information and procedural guidelines for IHS staff members to effectively perform their duties and responsibilities.
  5. Responsibilities.  The IHS is the Federal Agency charged with the responsibility for administering the delivery of health care services to American Indians and Alaska Natives.
    1. Director, Management Policy and Internal Control Staff.  The Director, Management Policy and Internal Control Staff (MPICS), is responsible for the directives management program in the IHS and for providing advisory services and assistance to IHS managers in the development, clearance, and distribution of IHS directives.

      The Director, MPICS, periodically assesses the directives issuance process and overall MPICS services.

    2. Agency Directives and Delegations Control Officer.  The Director, MPICS, is designated as the Agency Directives and Delegations Control Officer (DDCO).  The Agency DDCO is the principal contact for the Area Directors and Headquarters Office Directors regarding IHS manual system directives.  The Director, MPICS, provides guidance and assistance to IHS staff in accessing the HHS manual system and other Government directives.  As the Agency DDCO, the Director, MPICS, is responsible for ensuring that each IHS-issued directive is reviewed, on at least a biennial basis, and, if necessary, recommends that it be updated.  This is accomplished with the assistance of the MPICS management analysts (MA) who are designated as primary consultants and technical advisors to functional area managers and staff at IHS Headquarters and Area Offices.
    3. Management Policy and Internal Control Staff.  The MPICS is responsible for providing advisory services related to directives development and issuance to managers and staff at all levels in the IHS.  Services of the MPICS include the following:

      1. Advising functional area managers and staff on the appropriate formats for proposed directives from those described in this chapter.
      2. Advising functional area managers and staff of existing directives that require review and consideration for consolidation into a new or revised IHS manual system directive.  This includes reviewing all information released regarding policy, practices, and activities of the functional area, e.g., directives, memorandums, technical guides, and desk references.
      3. Providing advice and guidance to functional area staff regarding the general rules for writing directives, e.g., sentence structure, detail of information, section declension, and selection of appendices and exhibits.
      4. Ensuring that an official review and comment period is allowed for the drafts of proposed IHS directives and advising functional area staff during the development of final drafts of IHS directives.
      5. Establishing and maintaining a system for numbering and controlling IHS directives and for distributing approved and signed IHS directives.
      6. Maintaining a reference library that includes the IHS manual system issuances.
      7. Maintaining the IHS directives repository files.
      8. Maintaining an electronic library of all current IHS directives on the IHS Web site.
      9. Periodically evaluating the processes used for distributing drafts and final issuances of directives to all levels in the IHS.  This is accomplished with the cooperation of an IHS-wide network of DDCOs.
      10. Providing technical advice and assistance to Area DDCOs on services to their respective offices.
    4. Area Directors.  Each Area Director must designate a primary DDCO and at least one alternate DDCO for his/her organization.  The primary and alternate DDCO designations must be made through memoranda, and copies of the memorandums must be transmitted to the Agency DDCO.  Area Directors should also consult with the Chief Executive Officers of each IHS-operated service unit (SU) and with the Directors of each IHS-operated health center within their Area to designate a SU or a health center DDCO for each SU or facility.

      It is recommended that the annual performance plans of each designated DDCO include standards for measuring the performance of the DDCO.  The duties and responsibilities described in Section 1-1.1E(7), beginning on page 7, are key functions for a successful IHS directives and delegations program.

    5. Area Directors and Headquarters Office Directors.  Area Directors and Headquarters Office Directors are responsible for ensuring a review of all proposed directives is made by appropriate members of their staff.  If no comments are generated by the review, Area Directors are required to submit a memorandum to the Agency DDCO indicating “No Comment.”
    6. Functional Area Managers.  Functional area managers are responsible for ensuring that all IHS manual system directives related to their areas of responsibility always convey current, appropriate, and accurate guidance for users.  During the development of new or revised directives, or the development of IHS supplements to higher echelon directives, functional area managers must ensure that uncontrolled directives (memoranda, technical guides, desk references, etc.) that pertain to their functional area activities are reviewed and appropriately incorporated into the new or revised directive.  This assists in eliminating duplicate and conflicting policy and procedural information and ensuring that IHS-wide policy and practices are incorporated into an appropriate IHS directive format.

      The managers of Headquarters functional areas designated as Management Control Areas (MCA) under the IHS Federal Managers’ Financial Integrity Act (FMFIA) compliance program may be required to establish Management Control Systems (MCS) and incorporate them into the function-related IHS directive.  All MCS must be established in accordance with instructions in the IHM, Part 5, Chapter 16,“Management Control Systems.”

    7. Area Directives and Delegations Control Officers.  The Area DDCOs are the primary contacts in each Area for coordinating and advising staff Area-wide on the procedures for development, revision, or cancellation of Area-issued directives and for supplementing Headquarters-issued directives.  The Area DDCOs are responsible for the following:

      1. Coordinating and implementing the requirements of this chapter for their assigned IHS Area Office.
      2. Maintaining complete sets of the IHS manual system issuances, i.e., the IHM chapters and Area Office supplements, the IHS Circulars and Area Office supplements, and the IHS SGMs.
      3. Maintaining an index of all Area-issued supplements to IHS directives.
      4. Ensuring that the mailing lists for the distribution of manual issuances are kept current.
      5. Directing the local distribution and filing of the IHS manual system issuances, the IHS supplements, and Area Office issuances.
      6. Ensuring the timely distribution of all draft directives transmitted by the Agency DDCO for IHS-wide review and comment as well as draft directives prepared at the Area Office for Area-wide review and comment.
      7. Ensuring that functional area managers are given an opportunity to review and comment on proposed Area Office supplements to the IHS manual system issuances.
      8. Preparing memoranda for the signature of the Area Director to transmit comments received on proposed IHS Headquarters directives to the Agency DDCO, including memoranda indicating “No Comment.”
      9. Providing support to field technical staff charged as principals in drafting directives for application IHS-wide.
      10. Ensuring that the appropriate formats are used for directives initiated by managers in the Area Offices.
    8. Workgroup Council or Committee Chairperson(s).  The chairperson(s) of an IHS workgroup, council, or committee must ensure his/her charge/charter is incorporated into an IHS circular format.  The placing of the group’s charter into circular format will allow for better coordination, dissemination, follow-up, research and cataloging as well as for updating information about the workgroup.  When the workgroup, council, or committee’s charge/charter is released as a circular, it uses a common format, is assigned a tracking number, and is placed on the IHS Web site.  This allows all employees to be more aware of the workgroups in existence and to more easily track information on all IHS workgroups.

1-1.2  INDIAN HEALTH MANUAL

The IHM is the preferred reference for IHS staff regarding IHS-specific policy and procedural information.  Permanent policies, procedures, and operating standards specific and unique to IHS administrative and program operations are maintained in the eight parts of the IHM.  The IHM is also used to issue IHS-specific policies as a supplement to an HHS staff manual or GAM chapter.  The IHM chapters are generally developed under the direction of an IHS Headquarters functional area manager and staff with input from their managerial and functional area counterparts at the Area Offices and SUs.  Supplements to the IHM chapters may be developed and issued by an Area Office when additional instructions are required to reflect the Area’s particular practices.  Supplements issued by an Area Office cannot conflict with and must be consistent with the policy established in the issuances from IHS Headquarters and must be styled in the same format and specifically cite the sections of the Headquarters-issued chapters that are supplemented by the Area Office.

  1. Authority for IHM Chapters.  Only the Director, IHS, or his/her designee, may approve and authorize the release of IHM chapters.  Approval and authorization are indicated by the authorized official affixing his/her signature on the Transmittal Notice (TN) that covers the chapter issuance (see Section 1-1.3 and Manual Exhibit 1-1-A).

    An Area Director or his/her designee, may approve and authorize the release of Area Office supplements to the IHM chapters by affixing his/her signature on the TNs developed by the Area Office DDCO.

  2. Parts in the IHM.

    1. Part 1 - General.  Part 1 provides information concerning the IHM, IHS delegations of authority, the organization of the IHS, and general information on the administration of the IHS.
    2. Part 2 - Services to Indians and Others.  Part 2 includes chapters that establish IHS policies and procedures regarding services provided to American Indian and Alaska Native people and eligible non-Indians.
    3. Part 3 - Professional Services.  Part 3 includes the policies, responsibilities, and standards for the IHS direct health care delivery system and recommendations for Urban and Tribal health care delivery programs funded by the IHS.
    4. Part 4 - Staff Services/Special Programs.  Part 4 includes chapters that cite the policies, responsibilities, standards, and procedures related to special staff and support services and activities not covered by management service issuances contained in Part 5.  Examples include Equal Employment Opportunity/Civil Rights Staff Office issuances and issuances pertinent to employee integrity and ethics and to public affairs.
    5. Part 5 - Management Services  Part 5 contains chapters regarding the IHS administrative, management, financial, and program support policies as well as responsibilities, standards, and procedures, except for human resources administration and management.
    6. Part 6 - Services to Tribal Governments and Tribal Organizations.  Part 6 includes chapters that convey the administrative guidelines and internal practices to assist IHS staff in providing services and technical assistance to the Area Offices and Tribal Governments pertaining to implementation of Title I and Title V of Public Law (P.L.) 93-638, the Indian Self-Determination and Education Assistance Act, as amended.
    7. Part 7 - Human Resources Administration and Management.  Part 7 includes chapters that cover the policies, responsibilities, standards, and procedures governing the administration and management of the IHS personnel system.
    8. Part 8 - Information Resources Management.  Part 8 includes chapters that cover the policies, responsibilities, standards, and procedures governing the administration and management of IHS information resources.
  3. Indian Health Manual Chapter Format.  The various organizational coponents of the IHS have diverse missions, organizational structures, and policy/procedural requirements for their operations.  This diversity is reflected in the contents of each chapter.  (Use this chapter as an example of the required IHM chapter format.)  In IHM citations, the word "section" refers to the first and subsequent levels of breakdown below the chapter level.  As a general rule, sections are subdivided and designated only to the extent users of the manual may need to cite a specific subdivision of a section.  Each new section of text in an IHM chapter is indented five character spaces to the right of the left margin of the primary blocked text.  The IHM parts, chapters, sections, and subdivisions of sections are separated and identified by numeric and alpha digits in the following declension and form:

    1
    1-1
    1-1.1
    1-1.1A
    1-1.1A(1)
    1-1.1A(1)a
    1-1.1A(1)a(i)
    1-1.1A(1)a(i)(a)
    1-1.1A(1)a(i)(a)i
    IHM Part
    IHM Part and Chapter
    IHM Part, Chapter, and Section
    IHM Part, Chapter, Section and Section Subdivisions
    IHM Part, Chapter, Section and Section Subdivisions
    IHM Part, Chapter, Section and Section Subdivisions
    IHM Part, Chapter, Section and Section Subdivisions
    IHM Part, Chapter, Section and Section Subdivisions
    IHM Part, Chapter, Section and Section Subdivisions

    1. IHM Chapter Components.  The IHM chapters contain some common informational components.  To standardize the manual organization and to present the content of each chapter in a logical sequence, the IHM chapters (including revisions and Area Office supplements) are structured, to the extent practicable, as follows:

      1. Table of Contents.  Each IHM chapter must include a table of contents delineating the titles and numbers of sections and subsections in the text.  Exhibits and/or appendices (as allowed by the Agency DDCO) to the chapter must be listed at the end of the table of contents, appendices first.  The lists must include each exhibit or appendix number and title.  (See Exhibit 1-1-B for an example of an IHM chapter table of contents.)
      2. Table of Contents Page Headers.  The table of contents page headers contains the IHM Part title, chapter number, and chapter subject.  An example of a table of contents page “header” follows:
      3. GENERAL

        Chapter 1
        INDIAN HEALTH MANUAL SYSTEM



      4. Table of Contents Page Footers.  The table of contents page footers cite the IHM, date of the chapter issuance or update, and the Transmittal Notice number.  Footer information is presented in a single line that is over-scored.  Table of contents page numbers are indicated by lower-case roman numerals centered above the footer line.  An example of a “footer” for an IHM chapter table of contents page follows:
    2. i


      Indian Health Manual (00/00/2005) TN 2005-XX

    3. Chapter Section - General or Introduction.

      1. Purpose.  Contains information conveying the reason for the directive, i.e., to establish or document changes to policy, procedures, and staff responsibilities related to the operations and/or management of a particular IHS functional area.
      2. Background.
      3. Goals (Optional).
      4. Policy.  Contains information defining the methods or courses of action to be taken by IHS staff relative to the subject functional area.  The information contained in this section must be written in an active voice, present tense, i.e., the IHS "does," "must," or the IHS policy "is."  The policy statement should be brief and consistent with internal and external rules and regulations regarding the subject.  Lists of activities that are meant to clarify the policy, but which are usually requirements, should be included in the guidance/procedural text of directives.
      5. Other general information as appropriate.
    4. Chapter Section - Organizational Responsibilities.

      1. Director (as advised by the MPICS)
      2. Headquarters Staff
      3. Area Staff
      4. Service Unit Staff
      5. Other Organizational Staff
    5. Chapter Section - Procedures.

      1. Instructions/standards/requirements/criteria for management control/quality assurance requirements and indicators that would be applicable at all levels in the IHS.
      2. Other informational guidelines.
    6. Chapter Page Format.

      1. Chapter Page Headers.  Chapter page headers for the text pages of an IHM chapter must be contained within the 1-inch left and right margins of the chapter pages.  Chapter page headers convey the IHM part title, page number, chapter number, and chapter title.

        1. Even-numbered Chapter Page Header.  The IHM Part title is flush with the right margin, and the page number is flush with the left margin, as follows:
        2. Page 2

          GENERAL


          Chapter 1
          INDIAN HEALTH SERVICE MANUAL SYSTEM

        3. Odd-numbered Chapter Page Header.  The IHM Part title is flush with the left margin, and the page number is flush with the right margin, as follows:
        4. GENERAL

          Page 3


          Chapter 1
          INDIAN HEALTH SERVICE MANUAL SYSTEM

      2. Chapter Page Footers.  Footers for the text pages of an IHM chapter must be contained within the 1-inch left and right margins of the chapter pages.  Chapter page footer information reflects that the page is part of the IHM and includes the date the information on the page was approved for inclusion in the chapter and the TN.

        1. On even-numbered pages, the citation “Indian Health Manual” is flush with the right margin and the TN citation is flush with the left margin, as follows:

        2. TN 2005-XX
          (00/00/2005)

          Indian Health Manual

        3. On odd-numbered pages the citation “Indian Health Manual” is flush with the left margin, and the TN citation is flush with the right margin, as follows:

        4. Indian Health Manual
          (00/00/2005)

          TN 2005-XX


    7. Text Continued to New Page.  When a section of chapter text is continued to the next page, the continuation is noted under the header at the upper left of the page text by a series of numbers and alpha digits constructed as follows: parenthesis, IHM part number, dash, IHM chapter number, dot, chapter section, capital alpha digit of the subsection, parenthesis, subsection division number, close parenthesis, space, dash, space, the word “continued,” close parenthesis, e.g., (1-1.2C(5)a continued).
    8. Manual Exhibits/Appendix.  Manual Exhibits/Appendices provide supplemental information, forms, references materials, etc., in support of the material presented in the chapter.  (See Manual Exhibit 1-1-C, “Example - Indian Health Manual Appendix/Exhibit Format,” and Manual Exhibit 1-1-F, “Example - Circular Appendix/Exhibit Format.”)
    9. Manual Appendix.  A Manual Appendix normally contains information that significantly supplements the statements of policy and procedures in the text of an IHS directive.  Information in appendices may or may not have been developed by the IHS.  The information may include sections of Public Laws, higher echelon and Government oversight agency requirements, or segments of another IHS functional area policy/procedure that would apply to the functional area for which the directive is established.

      Since the President issued Executive Order 12861, it is not appropriate to include oversight agency policy and/or guidelines in their full text as an appendix to IHS directives.  Requirements for conformance to higher echelon or oversight agencies’ policy and/or guidance must be selectively synopsized in the policy/guidance/procedures section(s) of the IHS directive.  Source(s) for copies of the higher echelon or Government oversight agency guidance or policy must also be referenced within the text of the IHS directive.

      The IHM chapter appendices are distinguished from the chapter text by page headers and footers that reflect the IHM part and chapter number, the alpha digit assigned to the appendix, and the appendix page numbers.  The IHM chapter appendix page footers include the TN number and date of the TN.  See Manual Exhibit 1-1-C for an example of how the text of the chapter appendix page headers and footers alternate on each page of appendices from being flush with the right margin for odd-numbered pages to being flush with the left margin for even-numbered pages.

    10. Manual Exhibits.  Exhibits include copies of flowcharts, tables, or other graphics that might assist the reader in understanding the policies and procedures, management objectives, and expected outcomes as a result of staff compliance to the requirements in an IHS directive.  Manual Exhibits may also illustrate or provide templates of forms and formats of reports or correspondence to be used by staff when performing staff work and/or providing services.  (See Manual Exhibit 1-1-C.)

      Functional area managers whose activities require the use of existing standard or specifically designed forms must cite the applicable form numbers and approved dates within the text of the directive.  The source(s) or Web site where copies of the forms can be electronically retrieved must be included in the text of the directive.

      The IHM chapter exhibits are distinguished from the chapter text by page headers that reflect the IHM part and chapter number, the alpha digit assigned to the exhibit, and the exhibit page numbers.  The IHM chapter exhibit page footers include the TN number and date of the TN.

1-1.3  TRANSMITTAL NOTICES

A TN is a single-page document that covers each approved IHM chapter and subsequent revisions to IHM chapters.  The TN includes background information on the new or revised chapter, the Director’s signature, information on materials that are superseded by the issuance, and filing and disposition instructions.  (See Manual Exhibit 1-1-A for an example of an IHM TN).

1-1.4  DELEGATIONS OF AUTHORITY

Delegations of authority (DOA) are part of the IHM and are transmitted under a TN signed by the Director, IHS.  The DOA indices are maintained on the MPICS Web site; however, copies of the actual DOA documents are maintained in a reference library in the MPICS office:

  1. Original.  The original copy of each DOA is filed with charge memoranda, research documents, etc., in the directives repository file maintained in the MPICS Office, IHS Headquarters.
  2. Copies.  The MPICS maintains a reference library of the DOAs.
  3. Electronic Retrieval.  Each DOA may be retrieved electronically from the MPICS Web site:  http://www.ihs.gov/ihm/index.cfm
  4. Area Offices.  Copies of DOAs are immediately transmitted via U.S. mail to the Area DDCOs, filed in binders established for the DOAs, and maintained in central locations at the Area Offices.

1-1.5  AREA SUPPLEMENTS TO THE IHM

The Area Director, or his/her designee, may approve and authorize the release of Area Office supplements to the IHM by affixing his/her signature to the TNs developed by Area DDCOs.

  1. Page Headers and Footers for Area Supplements.  All headers in Area supplements to IHM chapter must include the title of the Area Office.

    Example:


    GENERAL
    ABERDEEN AREA

    Page 1


    Chapter 1
    INDIAN HEALTH MANUAL SYSTEM


  2. Page Footers for Area Supplements.  All footers used in Area supplements to an IHM chapter may use the same footer formats as described and illustrated in Section 1-1.2C(5)b on page 14.

1-1.6  INDIAN HEALTH SERVICE CIRCULARS

  1. Circular Format.  The IHS circular format may be used when specific guidance for an IHS program or administrative function and/or responsibility is required, or

    1. subject-matter policy and procedures are being developed incrementally over an extended period of time, or
    2. a decision/determination regarding the appropriate IHM chapter in which to incorporate new policy and procedures is not immediately available, or
    3. a workgroup charter is being incorporated into the IHM system.
  2. Authority.  Only the Director, IHS, or his/her designee, may approve and authorize the release of IHS Circulars.  Authorization to issue a prepared circular is obtained by the IHS Director's signature on the last page of the circular.
  3. Format for IHS Headquarters Circulars.  (See Manual Exhibit 1-1-D for an example of the IHS Headquarters circular format.)

    1. Information Sections.  The following information sections are recommended for IHS circulars issued by Headquarters and Area Offices.  However, the information contained in IHS circulars is dependent on the functional area managers' and staff needs for adequately conveying subject-matter information and administrative requirements.

      1. Purpose.  Explanation of why the circular is being issued and specific objectives.
      2. Background.  Inclusion of Public Law titles, higher-echelon directives, or specific requirements for program or administrative activities to meet higher-echelon directives, legislative or statutory requirements, etc., that compel issuance of the circular.
      3. Policy.  (As available; administrative procedures may be the only information available for inclusion in IHS circulars, pending a policy statement.)
      4. Organizational Responsibilities.  Description of the responsibilities of the functional area managers accountable for successfully overseeing and accomplishing the functions covered by the IHS circular.
      5. Procedures/Instructions/Operations Information.  General information for readers and specific guidance for the functional area staff.
      6. Supersedure.  List of previously issued controlled and uncontrolled directives that the circular information is replacing, if any.
      7. Effective Date.  Citation of a specific date that IHS employees’ compliance to the requirements of the circular is to begin, which is usually the date of signature; however, a circular may be issued in advance of the effective date.

    2. Circular Section Designations.  Principal sections of IHS circulars are designated by numerical digits; paragraphs and subparagraphs within a section are designated by numeric and alpha digits in the following declension and form:
    3. 1  Section number
      1A  Section, paragraph
      1A(1)  Section, paragraph, sub-paragraph
      1A(1)a  Section, paragraph, sub-paragraph, sub-paragraph sections
      1A(1)a(i)  Section, paragraph, sub-paragraph, sub-paragraph sections
      1A(1)a(i)(a)  Section, paragraph, sub-paragraph, sub-paragraph sections

    4. Circular Page Headers and Footers.  Headers and footers for the text pages of IHS circulars must be contained within 1-inch margins (left, right, top and bottom) on each page.
    5. Circular First Page Header.

      1. Only the first page of an IHS circular contains both a header and a footer.
      2. Text pages after the first page, and appendices and/or exhibits to a circular, have only headers.
      3. The header on the first page of an IHS circular includes the address of the IHS department, the originating Headquarters Office, and the IHS circular number.  Example of an IHS circular first-page header:
    6. DEPARTMENT OF HEALTH AND HUMAN SERVICES

      Indian Health Service
      Rockville, Maryland 20852

      Refer to:  OCPS

      INDIAN HEALTH SERVICE CIRCULAR NO. 2005-XX


    7. Circular First Page Footer.  The footer on the first page of an IHS circular notes the distribution and the date that the circular is approved and signed by the Director, IHS, or his/her designee.  This information is inserted under a single overscore line.  Example of the IHS circular first-page footer:


      Distribution:  IHS-wide
      Date:

    8. Circular Headers on the Second and Subsequent Pages.  Headers on the second and subsequent pages of IHS circulars include the circular page number, IHS circular number, and the date that the circular is approved and signed by the Director.  The page number citation is flush with the left margin, and the date is flush with the right margin on even-numbered pages.  On odd-numbered pages, the page number citation is flush with the right margin, and the date is flush with the left margin.  The circular number is always centered in the header line of each page.  Example of IHS circular even-numbered page header:
    9. Page 2 INDIAN HEALTH SERVICE CIRCULAR NO. 2005-XX

      (00/00/2005)


      Example of IHS Circular odd-numbered page header:

      (00/00/2005) INDIAN HEALTH SERVICE CIRCULAR NO. 2005-XX

      Page 3


    10. Circular Appendices/Exhibits.  (See Section 1-1.2C(7) and (8) of this chapter regarding the requirements for IHS directives’ appendices and the text for exhibits.)  Circular appendices and exhibits are distinguished from the circular text pages by a header that reflects the circular number, alpha digit assigned to the appendix/exhibit, appendix/exhibit page numbers, and date of the appendix/exhibit (See Manual Exhibit 1-1-F.)  See Manual Exhibit 1-1-D for an example of how the text of the exhibit headers and footers alternate on each page of the appendix/exhibit from being flush with the right margin for odd-numbered pages, to being flush with the left margin for even-numbered pages. Functional area managers who use guidance or policy and procedures developed in formats other than the IHS manual system directives, and whose activities require the use of existing standard or specifically designed forms, must cite the applicable guidance and form numbers within the text of the circular.

      The sources for copies of the directives and forms must be cited in the text of the circular.

  4. Consolidation.  Except for workgroup charters, the IHS circular format is used to issue IHS policy and/or operating procedures; the information contained in an IHS circular must be consolidated into an existing or a new IHM chapter within 2 years.

1-1.7  AREA OFFICE CIRCULARS

  1. Title Page Headers for Area Office Circulars.  Area Office circulars and supplements to IHS circulars must be formatted as illustrated above, except that the headers must include the Area Office title.  (See Manual Exhibit 1-1-E for an example of the IHS Area Office circular format.)

    Example of Area circular supplement title-page header:

    DEPARTMENT OF HEALTH AND HUMAN SERVICES

    Indian Health Service
    California Area


    Refer to:

    INDIAN HEALTH SERVICE CIRCULAR NO. 2005-XX


    Example of Area Office circular and IHS circular supplement title-page footer:
    Distribution:  California Area Office
    Date:

  2. Headers for the Second and Subsequent Pages.  Example of headers for the second and subsequent pages of Area Office supplements to IHS circulars:

    Example of Area circular supplement even-numbered page header:

    CALIFORNIA AREA

    Page 2 INDIAN HEALTH SERVICE CIRCULAR NO. 2005-XX

    (00/00/2005)


    Example of Area circular supplement odd-numbered page header:

    CALIFORNIA AREA

    (00/00/2005) INDIAN HEALTH SERVICE CIRCULAR NO. 2005-XX

    Page 3


1-1.8  CLEARANCE OF IHS AREA OFFICE DIRECTIVES

  1. Distribution of Draft Area Office Directive for Review and Comment.  The Primary DDCO in each Area is responsible for soliciting comments from appropriate managers and staff within his/her Area and from the appropriate Headquarters functional area managers when a Headquarters-issued directive is supplemented at the Area level.  Requests for IHS Headquarters reviews must be made through the Agency DDCO.  The Area Office draft supplemental issuance is transmitted electronically to the Agency DDCO.
  2. Consideration and Use of Comments and Recommendations.  Area Offices should establish timeframes for the Area Office review and comment process.

1-1.9  SPECIAL GENERAL MEMORANDUM

The Special General Memorandum (SGM) is for the exclusive use of the Director, IHS, or his/her designee.  An SGM is normally used to interpret and/or reiterate existing IHS policy that requires special attention by IHS employees.  The SGM format may also be used to announce new policy and/or procedural requirements that must be implemented immediately.

Functional area managers at Headquarters who determine a need for an SGM are responsible for preparing the SGM and submitting it to the Director, MPICS, who will transmit the SGM to the Director, IHS, for signature.  Prepared SGMs must be submitted under a standard action memorandum through the Executive Secretariat Staff (ESS) and the MPICS.  (See Manual Exhibit 1-1-G for an example of an SGM.)

Upon the approval and release of an SGM, the Agency DDCO designates an MPICS member to contact the appropriate functional area managers to begin incorporating the SGM information into an appropriate IHM chapter or IHS circular, or as a supplement to a higher-echelon directive.

  1. Authority.  Only the Director, IHS, or his/her designee, may approve and sign an SGM.
  2. Format for an SGM.  The Director’s SGMs are prepared in the memorandum format prescribed in the Indian Health Service Executive Correspondence Guidelines.  As an official IHS directive format, the SGMs are normally prepared as information to all IHS employees; however, on occasion they may be developed for and distributed to select functional area managers and staff.
  3. Control Numbers.  The Agency DDCO assigns a control number to each SGM upon signature by the Director, IHS, or his/her designee.  The control number is configured to reflect the calendar year and sequential number of issuance, e.g., SGM 2005-01, SGM 2005-02, etc.
  4. Area Office SGMs.  Area Directors are encouraged to establish and maintain a memorandum system for each Area’s use that is similar to the one used for the Director’s SGMs.

1-1.10  INDIAN HEALTH SERVICE MANUAL SYSTEM STYLE GUIDELINES

Functional area managers are responsible for ensuring that all final directives and related documents (briefing memoranda, action memoranda, TNs, etc.) submitted to the Director for signature are prepared using the Times New Roman font, 12 characters per inch (12 cpi, pt).  All directives’ text is in standard block style with left print justification only.  All margins (left, right, top, and bottom) are set at 1 inch on each page, including headers and footers.

1-1.11  DIRECTIVES DEVELOPMENT PROCESS

  1. Notification.

    1. Functional area managers at Headquarters should contact the Agency DDCO when they recognize the need to develop, revise, or cancel an IHS directive.
    2. Area Office and other field staff who recognize a need for IHS directives’ development or revisions to an IHS directive should contact the subject functional area manager in the Area Office, the Headquarters functional area manager, and/or the Agency DDCO.
    3. The Division of Regulatory and Legal Affairs, Office of Management Services, is consulted as needed during the directive development process.
  2. Designation of Management Policy and Internal Control Staff Assistance.  Upon receipt of a notice or request for assistance, the Agency DDCO designates an MPICS MA to be the primary coordinator for advisory and assistance services to functional area staff.  The designated MA assists the functional area manager/staff in developing a work plan that delineates specific mileposts for completing the directive action and remains available to provide advice and guidance throughout the directive development and issuance process.
  3. Headquarters Functional Area Managers.  Managers at Headquarters whose functional areas are designated as MCAs under the IHS FMFIA compliance program should first outline or establish an MCS.  This could assist in the development of the directive.  (See Section 1-1-E(6)).
  4. Contracted Directives Development.  When the development of a directive is contracted, the functional area manager shall arrange a meeting with the Agency DDCO (and/or the designated MPICS MA) and the contractor to ensure that the contractor is aware of the requirements of this chapter.
  5. Directives Development Workgroups.  The number of individuals involved and the period of time necessary to develop a directive varies depending on the subject and complexity of the information/policy statements to be included.  Functional area managers and the MPICS acknowledge the importance of current written policies and procedures, and ensure expediency in developing and revising IHS directives.

1-1.12  CLEARANCE OF IHS DIRECTIVES

  1. Submission for Approval.  Two copies of the draft directive shall be transmitted for approval to the Agency DDCO: (1) A printed copy of the draft directive, including the table of contents, exhibits, and proposed/approved appendices, via memorandum, and (2) an electronic copy of the directive, including the table of contents, exhibits, and proposed/approved appendices, via e-mail.
  2. Headquarters Review and Comment Period.  Upon approval by the Agency DDCO, the drafts of IHM chapters and IHS circulars are transmitted via e-mail to Area and Headquarters Offices’ for a controlled review and comment period.  The review and comment period for IHM chapters and IHS circulars is a minimum of 20 calendar days from the date the draft is released and normally does not exceed 45 calendar days.  The Agency DDCO may extend the review and comment period upon the concurrence of the appropriate functional area managers.
  3. Exceptions to Review and Comment Periods.  The IHS directives review and comment period may be shortened under the following circumstances:

    1. The immediate implementation of the policy and/or procedural changes mandated by an Executive Order, Congress, the Office of Management and Budget, the Government Accountability Office, the Office of the Secretary, HHS, or a Federal oversight agency would be delayed.
    2. The directive is a product of workgroups composed of select IHS functional managers or staff, Tribal and/or Urban program/organization representatives, and/or other Federal agencies specifically charged by the Director, IHS, to develop and implement management, administrative, or program-improvement actions.

  4. Reviewers.  Each Area DDCO is responsible for ensuring that the electronic documents are forwarded to Area staff by forwarding the e-mail message or locally printing, duplicating, and distributing copies to staff/individuals designated in the MPICS MA e-mail message.

    The following individuals are extended an opportunity to review and comment on draft IHM chapters and IHS circulars proposed by Headquarters functional area managers, as appropriate to the nature of the directive:

    1. Area and Headquarters Office Directors
    2. Headquarters Division Directors
    3. Headquarters Functional Managers
    4. Area Executive Officers
    5. Area Chief Medical Officers
    6. Chief Executive Officers/Health Center Directors
    7. Tribal and Urban Indian health program officials from programs affected by or subject to an IHM chapter or an IHS circular
    8. Subject Functional Area Managers and Staff at Area Offices and Headquarters
    9. All DDCOs
    10. The IHS Records Management Officer (when the directives propose files/records management-related instructions that differ from the information contained in IHM Part 5, Chapter 15, “Records Management”)
    11. Bargaining unit officials, through the IHS Labor Relations Specialist (when directives impact the working conditions of bargaining unit employees)
  5. Consideration and Use of Comments and Recommendations.  The following steps apply during the development of an IHS directive at Headquarters:

    1. The MPICS and functional area staff have 45 calendar days in which to review, consider comments and recommendations, and incorporate accepted recommendations into the final draft of the directive.  This 45-day period begins the day after the review and comment period ends.
    2. Workgroups charged by the Director, IHS, or executive-level committees may be extended additional time to review comments and recommendations depending on the frequency with which the workgroup is able to meet.  The extended time lines are established among the workgroup chair(s), the charging official, and the Agency DDCO.
    3. Headquarters functional area managers or the members of the workgroup must address all concerns and recommendations made by the reviewers during the official review and comment periods.  A written report of the deliberations on comments and recommendations must be prepared by the functional area manager/staff and must accompany the final draft and action memorandum submitted for clearance by the Agency DDCO.  The report includes reasons why any recommendations are not incorporated into the final draft.  This written report becomes part of the official record related to the directive.
  6. Preparation of Directive Transmittal Package.  The directive package is submitted, under a standard action memorandum, through the MPICS and the Executive Secretariat Staff (ESS), to the Director, IHS.  Directives developed under charge from the Director or by another executive-level committee are cleared and submitted under an action memorandum from that workgroup or committee, through the MPICS and the ESS, to the Director, IHS.
  7. Transmittal of Directive for Signature.  The MPICS will conduct the final review of all documents to ensure format and information requirements are met.  The MPICS ensures that the final document is appropriately packaged for ESS review and approval, and the Director’s signature.

1-1.13  CONTROL, DISTRIBUTION, AND FILING OF IHS DIRECTIVES

Upon signature by the Director, IHS, the directive is returned to the MPICS for assignment of control and transmittal numbers.  A reference copy of each signed directive, regardless of format, is immediately transmitted via U.S. mail to the Area Offices by the Agency DDCO.  The Area DDCOs are responsible for ensuring that the Area Office Directors, Area Executive Officers, Chief Executive Officers/Health Center Directors, subject-matter functional area managers, and other individuals within their Area receive an electronic or printed copy of the directive.  A printed copy of the signed directive is filed as follows:

  1. Indian Health Manual Chapters.

    1. The original file copy of each chapter and the original of the signed TN for that chapter are filed in the directives repository file maintained in the MPICS Office, IHS Headquarters.
    2. The MPICS maintains a reference library of copies of the chapter and TN.
    3. Each chapter may be retrieved electronically from the MPICS Web site:

      http://www.ihs.gov/ihm/index.cfm.

    4. A reference copy of each chapter is transmitted via U.S. mail to the Area DDCOs and is filed in a binder established for that part of the IHM and maintained in a central location at each Area Office.

  2. Indian Health Service Headquarters Circulars.

    1. The original file copy of each circular is filed in the directives repository file maintained in the MPICS office, IHS Headquarters.
    2. The MPICS maintains a reference library of copies of the circular.
    3. Each circular may be retrieved electronically from the MPICS Web site:

      http://www.ihs.gov/ihm/index.cfm

    4. A reference copy of each circular is immediately transmitted via U.S. mail to the Area DDCOs and is filed in a binder established for IHS circulars and maintained in a central location at each Area Office.
  3. Special General Memorandum.  The Director’s SGM usually reiterates information and practices contained in an existing policy directive or is issued to implement recommendations by the Council and are not released for review and comment prior to signature by the Director or his/her designee.  The Director’s SGMs are filed in sequential order of issuance.

    1. The original file copy of each SGM is filed with the charge memorandum, research documents, etc., in the directives repository file maintained by the MPICS at IHS Headquarters.
    2. The MPICS maintains a reference library of copies of the SGM.
    3. Each SGM may be retrieved electronically from the MPICS Web site:

      http://www.ihs.gov/ihm/index.cfm

    4. A reference copy of each SGM is immediately transmitted via U.S. mail to the Area DDCOs and is filed in a binder established for the SGMs and maintained in a central location at each Area Office.

1-1.14   PROCEDURES FOR RESCINDING IHS MANUAL SYSTEM DIRECTIVES

  1. Indian Health Manual Chapters.  Generally, IHM chapters are not rescinded.  Information in the IHM chapters may be updated by updating a page or replacing the entire chapter.  Guidance regarding the disposition of superseded pages or copies of the chapters are included in the TNs.  The superseded copies of chapter information and related documents are retained and disposed of by the Agency DDCO in accordance with the IHS Records Disposition Schedule (RDS).
  2. Indian Health Service Circulars.  The IHS circulars are normally incorporated into existing IHM chapters or transcribed into new IHM chapters.  On occasions when IHS circular information is rescinded (not incorporated or transcribed into another directive format) or the circular information is updated or revised, an Errata Notice.  (See Manual Exhibit 1-1-H) is issued regarding the action that contains guidance to the recipients for disposition of their copies of the superseded IHS circular.  The superseded copies of IHS circulars and related documents are retained and disposed of by the Agency DDCO in accordance with the IHS RDS.
  3. Special General Memorandum.  An SGM expires on a specific date that is cited in the body of the memorandum.  Functional area managers who request that the subject matter of an SGM continue in effect beyond 1 year are required to develop and submit a new memorandum for the Director’s signature in accordance with the requirements of this chapter.  Copies of the SGMs are retained and disposed of by the Agency DDCO in accordance with the IHS RDS.

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