View Information Collection (IC)

View Information Collection (IC)

IC Title:	Survey of Veteran Enrollees' Health and Reliance Upon VA	Agency IC Tracking Number:	2900-0609

Is this a Common Form? No		IC Status: Modified

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
Form and Instruction	10-21034G	Survey of Veteran Enrollees w/VE Questions	Survey of Veteran Enrollees Health and Use of Health Care_04_23_2018 (002).docx		No		Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title: 97VA105, “Consolidated Data Information System-VA	FR Citation: 72 FR 46130

Number of Respondents: 42,000	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	42,000	0	0	0	0	42,000
Annual IC Time Burden (Hours)	14,000	0	0	0	0	14,000
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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