Information Collection

Consumer Sampling Letter - Va Hospitals

IC 147514 under ICR 198408-2900-022 · OMB 2900-0190.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

CONSUMER SAMPLING LETTER - VA HOSPITALS

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA FL				No	No
Form	27-652A				No	No

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,770

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	10,770	10,770
Annual IC Time Burden (Hours)	1,795	1,795
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

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