Information Collection

CFI 141 USDA NASS, CFI 142 VA Outpatient, CFI 143 VA Inpatient

IC 182649 under ICR 200707-1505-001 · OMB 1505-0191.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CFI 142 CFI 141 USDA NASS, CFI 142 VA Outpatient, CFI 143 VA Inpatient	Form
CFI 141 USDA NASS questionnaire CFI 141 USDA NASS.doc	Form
CFI 142 VA Outpatient Questionnaire CFI 142 VA Outpatient Questionnaire.doc	Form
CFI 143 VA Inpatient questionnaire CFI 143 VA Inpatient Questionnaire.doc	Form

IC Title:

Agency IC Tracking Number:

CFI 141, CFI 142, CFI 143

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	CFI 142	VA Outpatient Questionnaire	CFI 142 VA Outpatient Questionnaire.doc	No	Paper Only
Form	CFI 143	VA Inpatient questionnaire	CFI 143 VA Inpatient Questionnaire.doc	No	Paper Only
Form	CFI 141	USDA NASS questionnaire	CFI 141 USDA NASS.doc	No	Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 780

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	780	0	0	0	0	0
Annual IC Time Burden (Hours)	156	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	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.