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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
PTSD Family Caregiver Feedback/ARCH Focus Group/VA Courtesy Standards/PTSD Coach (Phone) Apps Survey
Agency IC Tracking Number:
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
5 CFR 1320.8(d)
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
VA Form 10-0495
Understanding PTSD for Family Caregivers: Feedback Survey
PTSD and Family Caregivers Survey 10-0495.docx
https://slu.qualtrics.com/SE/?SID=SV 7P6Zja6FxuVnhwF
Yes
Yes
Fillable Fileable
Other-Telephone Script
ARCH_Focus_Group_Telephone_Script_(2)[1].docx
No
Paper Only
Instruction
ARCH_Focus_Group_Discussion_Guide1.pdf
No
Paper Only
Form
VA Form 10-0497
VA Courtesy Standards - The Golden Rule Approach Veteran Feedback Form
VA Courtesy Standards-Golden Rule Approach 10-0497.doc
No
Paper Only
Form
VA Form 10-0496
PTSD Coach App Survey
PTSD Phone Apps Survey 10-0496_v3.pdf
No
Paper Only
Other-Focus Group Guide and Script
Phone_Apps_Focus_Group_Guide_and_Script_(v4)[1].docx
No
Paper Only
Other-Notification Letter
ARCH FocusGroup Letter.docx
No
Paper Only
Form
VA Form 10-0496a
Phone Apps Focus Group Demographic Questionnaire
Phone Apps_Focus Group Demographic Questionnaire (v5)(A).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:
4,420
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
4,420
0
0
0
0
4,420
Annual IC Time Burden (Hours)
1,353
0
0
0
0
1,353
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Feedback on Caregiver PTSD Training
Generic_Request_PTSD_Caregiver_Training (v2).docx
12/06/2012
Project ARCH Focus Group
Generic_Request_ARCH_FocusGroup[1].docx
12/10/2012
VA Courtesy Standards-Golden Rule Approach
Generic_Request_VA Courtesy Standards.docx
12/04/2012
PTSD Phone Apps Focus Grp and Survey
PTSD_Phone_Apps_Focus_Group-Survey_Submission_(v3).docx
12/11/2012
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.