View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Dialysis Patient Satisfaction Survey - Lebanon VAMC	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-Survey			Dialysis Patient Satisfaction Survey - Lebanon VAMC_updated Feb 2022.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: 95	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	95	0	95	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 Supporting Statement - Dialysis Patient Satisfaction Survey - Lebanon VAMC - updated Feb 2022	Generic Supporting Statement_Dialysis Patient Satisfaction Survey - Lebanon VAMC_updated Feb 2022.docx	03/16/2022

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