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

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     Indian Health Manual

Exhibit 1-40-A


General Administration Manual
IHS Transmittal 94.01 (09/09/94)

1.  Area Office


2.  Conference Name

3.  Conference No.

4.  Dates

5.  Conference Location & Site

Federal______ Non-Federal______Tribal______
(Attach cost comparison and quotes from at least three sources)

Justification of Out-of-Area Location or Non-Federal Factility

6.  Estimated No. of attendees: HQ______ AREA______ TRIBAL______ OTHER______

Total number of attendees for which IHS is to pay T&TP________

7.  Projected source(s) of estimated conference funds (indicate estimated obligations from appropriate source(s)):

A.  Operations $______* C. Contract Award $______

B.  Grant Award $______ D. Co-op Agreement $______

*For operational funds only, indicate estimates of:

8.  TRVL & PD $_____ FACILITIES $_____ SERVICES $_____ MATERIALS $_____

HONORIA $_____ TIME $_____ COST $_____ TOTAL $_____

9.  Areas and organizations Represented:

10.  Conference Objectives and Purpose (How do these fit into Agency mission.)

11.  Contact name and Phone No:

APPROVED_________ NOT APPROVED___________ DATE_____________

Area/Associate Director
(All information must be completed and proposal signed before approval)

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