Information Collection

CFI 188 HHS NCI Live Help, CFI 189 VA VHA CHAMPVA

IC 187666 under ICR 200707-1505-001 · OMB 1505-0191.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form CFI 188 CFI 188 HHS NCI Live Help, CFI 189 VA VHA CHAMPVA	Form
CFI 188 HHS NCI Live Help questionnaire CFI 188 HHS NCI Live Help.doc	Form
CFI 189 VA VHA CHAMPVA questionnaire CFI 189 VA VHA CHAMPVA.doc	Form
Justification for ICs to generic ICR 1505-0191.doc Justification for ICs to generic ICR 1505-0191	IC Document

IC Title:

Agency IC Tracking Number:

CFI 188, CFI 189

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	CFI 188	HHS NCI Live Help questionnaire	CFI 188 HHS NCI Live Help.doc		Yes	Yes	Fillable Fileable
Form	CFI 189	VA VHA CHAMPVA questionnaire	CFI 189 VA VHA CHAMPVA.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: 520

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

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	520	0	0	0	0	0
Annual IC Time Burden (Hours)	104	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
Justification for ICs to generic ICR 1505-0191	Justification for ICs to generic ICR 1505-0191.doc	12/23/2008

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