Permanent policies, procedures, and operating standards unique to IHS administrative and program operations are maintained in the seven parts of the IHM. In addition to the IHM chapters, the IHS Circular format is used to issue temporary IHS operating policy. Special General Memoranda (SGM) are used to interpret or reiterate existing IHS policy that requires special attention by IHS employees. The SGM format may also be used to announce new IHS policy that must be implemented immediately.

Only the Director, IHS or his/her designee, may approve and authorize the release of IHM chapters, IHS Circulars and SGMs. Within the Office of Management Support, the Director, Management Policy Support Staff is designated as the Agency Directives and Delegations Control Officer, responsible for providing advisory services and assistance to IHS managers for the development, clearance and distribution of IHS policy directives.

IHS policies are generally developed under the direction of an IHS Headquarters functional area manager, with input provided from managers and functional area counterparts at the Area Offices and Service Units.

Part 1, Chapter 1 of the IHM covers the administration and maintenance of the IHS Manual system in more detail.