View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	VHA Veteran Inpatient Services VEO Survey / VBA Contact Center	Agency IC Tracking Number:

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
Other-eSurvey			Inpatient_SurveyMockup_103118_v4.pdf	TBD	Yes	Yes	Fillable Fileable
Other-eSurvey			VBACC_SurveyMockup_10.31.18_V1.2.pdf	TBD	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 236,112	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	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	236,112	0	236,112	0	0	0
Annual IC Time Burden (Hours)	7,870	0	7,870	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
VHA Veteran Inpatient Services VEO Survey	Inpatient_FastTrackClearance_10.23.18.docx	11/01/2018
VBA Contact Center	VBACC_FastTrackClearance_10.30.18.docx	11/01/2018
Inpatient Sampling	Inpatient Sampling Plan_102318.docx	11/01/2018
VBA Contact Center Sampling Plan	VBA CC Sampling Plan_10.30.18.docx	11/01/2018
Inpatient Email Mock Up	Inpatient_EmailsMockup_102518_v4.pdf	11/01/2018
VBA Contact Center Email Mock-Up	VBACC_EmailMockup_10.31.18_V1.2.pdf	11/01/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.