View Information Collection (IC)
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Agenda
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ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Extended Hours Program Evaluation, Maternity Care Coordination, Advanced Education Veteran Survey, State Veterans Home Administrator Survey, VOV Conjoint Survey
Agency IC Tracking Number:
2900-0770
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
10-10129
Extended Hours Evaluation - Non-Users
Extended Hours Program Evaluation - Non-Users Survey_v2-2.docx
No
Fillable Printable
Form and Instruction
10-10132
Extended Hours Evaluation - Users
Extended Hours Program Evaluation - Users Survey_v2-1.docx
No
Fillable Printable
Form and Instruction
10-10131
Maternity Care Coordination Survey
Maternity Care Coordination Survey_FINAL_Mattocks (3).docx
No
Fillable Printable
Form and Instruction
10-10128
Advanced Education Veteran Survey
SOU-SORCC-Patient-Survey.docx
No
Fillable Printable
Form and Instruction
10-10136
State Veterans Home Admin Survey
SVH Admin Survey.docx
No
Fillable Printable
Form and Instruction
10-10144
Voice of the Veteran (VOV) Satisfaction Survey Office of Strategic Integration (OSI) Conjoint Analysis
VHA_OSI Conjoint_Primary Care_Survey_11-21-14 Final (1) (CR 12 29 14).doc
No
Fillable Printable
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:
1,840
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
1,840
0
1,840
0
0
0
Annual IC Time Burden (Hours)
521
0
521
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Generic Clearance - State Veterans Home
Generic_Clearance_Submission_SVH Survey.docx
11/05/2014
Advanced Education Survey Request
VA SORCC Request 9 5 14.docx
11/05/2014
Advanced Education Survey Request
VA SORCC Request 9 5 14.docx
11/05/2014
Generic Clearance - State Veterans Home
Generic_Clearance_Submission_SVH Survey.docx
11/05/2014
V1 Extended Hours Generic Clearance
VISN1EHProgram_VA Generic Fast-Track Clearance Request.docx
11/05/2014
VA Maternity Care Coordination Generic Clearance
VA Generic Fast-Track Clearance Request Template_Mattocks_Maternity Care Coordination.docx
11/05/2014
ICR Request Voice of the Veteran (VOV) Satisfaction Survey Office of Strategic Integration (OSI) Conjoint Analysis
VA Generic Fast-Track Clearance Request_VHA OSI Primary Care Conjoint Analysis_11 21 14.docx
12/22/2014
Fast Track Review Request
IOM Conjoint Survey Fast Track Request White Paper (3) (CR 12 29 14).docx
12/29/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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