View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Veteran Hybrid Tele-Neuropsychological Evaluation - Satisfaction Survey	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-Survey			Hybrid Tele-Neuropsychological Visit - Patient Satisfaction Survey_updated Dec 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: 50	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	50	0	50	0	0	0
Annual IC Time Burden (Hours)	8	0	8	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Supp Statement - Veteran Hybrid Tele-Neuropsychological Evaluation - Satisfaction Survey - Dec 2021	Generic Supp Statement_ Hybrid Tele-Neuropsychological Visit - Patient Satis Survey_updated Dec 2021_v2.docx	12/21/2021

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