View Information Collection (IC)
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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Spinal Cord Patient Survey; Caregiver Training Participant Feedback; Income Verification Survey; Non-VA Care Vet Survey; Neuro-Rehab Satisfaction Survey
Agency IC Tracking Number:
2900-0770
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
5 CFR 1320.9
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
VA Form 10-0515
Spinal Cord Injury Patient Survey
Spinal Cord Injury Patient Survey_10-0515[v2].doc
No
Paper Only
Form
VA Form 10-0520
National Family Caregiver Participant Training Feedback Form
National Family Caregiver Participant Training Feedback Form 10-0520 (2).doc
URL to be determined by VA
Yes
Yes
Fillable Fileable
Form
VA Form 10-0541
Survey of Veterans' Satisfaction with Income Verification
Survey of Veterans' Satisfaction with Income Verification_10-0541[v2].pdf
No
Paper Only
Form
VA Form 10-0545
Non-VA Care Coordination Veteran Satisfaction Survey
Non-VA Care Coord Veteran Satisfaction Survey 10-0545[v2].docx
No
Paper Only
Form
VA Form 10-0546
Nuerology/Rehabilitation Inpatient Program Satisfaction Survey
Neuro Rehab Patient Survey_10-0546[v2].docx
No
Paper Only
Other-Survey Cover Letter
Income Verification_Veterans Survey Letter.doc
No
Paper Only
Other-Survey Cover Letter
Non-VA Care Survey Cover Letter[v2].docx
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
12,920
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
12,920
0
0
0
0
12,920
Annual IC Time Burden (Hours)
1,335
0
0
0
0
1,335
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Spinal Cord Injury Patient Care Survey
Generic Request_Spinal Cord Injury Patient Care Survey[v2].docx
04/23/2012
National Family Caregiver Comprehensive Training Program Participant Feedback
Generic Request_Nat Family Caregiver Training Participant Feedback (2).docx
04/16/2012
Survey of Veterans' Satisfaction with the Income Verification Process Service
Generic Request_Vet Satisfaction with Income Verification Svc(v2).docx
04/23/2012
Non-VA Care Coordination Veteran Satisfaction Survey
Generic Request_Non-VA Care_Coordination Veterans Satisfaction Survey(v2).docx
04/23/2012
Neurology/Rehabilitation Inpatient Program Satisfaction Survey
Generic Request_Neuro Rehabilitation Satisfaction Survey.docx
04/16/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.