View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Community Living Center (CLC) Survey (VISN 1-Bedford)	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			Community Living Center (CLC) Survey_VISN 1-Bedford_updated Mar 2022.docx		Yes	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: 1,500	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	1,500	0	1,500	0	0	0
Annual IC Time Burden (Hours)	750	0	750	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Supporting Statement - Community Living Center (CLC) Survey - (VISN 1-Bedford)	Generic Supporting Statement_Community Living Center (CLC) Survey_VISN 1-Bedford_updated Mar 2022.docx	03/22/2022

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