View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	NCHS Breast Cancer Wellness Recovery - Peer Support Need Questionnaire	Agency IC Tracking Number:	VHA-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
Other-Questionnaire			NCHS Breast Cancer Wellness Recovery Peer Support Need Questionnaire_updated June 2021.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: 125	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	125	0	125	0	0	0
Annual IC Time Burden (Hours)	125	0	125	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Supp Statement - Breast Cancer Wellness Recovery Support Need Questionnaire	Generic Supp Stmt_NCHS Breast Cancer Wellness Recov Peer Supp Need Questionnaire_updated June 2021.docx	07/30/2021

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