Information Collection

VA Voluntary Customer Surveys to Implement E.O. 12862

IC 28764 under ICR 200702-2900-005 · OMB 2900-0569.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0569 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
2900-0569 Survey.pdf www.vba.va.gov/surveys	Other-Survey

IC Title:

VA Voluntary Customer Surveys to Implement E.O. 12862

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Other-Survey			2900-0569 Survey.pdf	www.vba.va.gov/surveys	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 95,260

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 10 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	95,260	95,260
Annual IC Time Burden (Hours)	19,505	19,505
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.