Information Collection

Prevalence and Clinical Course of Depression Among Patients with Heart Failure, VA HSR&D, Nursing Research Initiative No. 05-209-3

IC 184350 under ICR 200804-2900-010 · OMB 2900-0719.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0719 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-21085a, Prevalence and Clinical Course of Depression Among Patients with Heart Failure, VA HSR&D, Nursing Research Initiative No. 05-209-3	Form and Instruction
VA Form 10-21085a, Prevalence and Clinical Course of Depression Among Patie Research_Questionnaire_Booklet1.pdf	Form and Instruction

IC Title:

Prevalence and Clinical Course of Depression Among Patients with Heart Failure, VA HSR&D, Nursing Research Initiative No. 05-209-3

Agency IC Tracking Number:

Is this a Common Form? No

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 and Instruction	VA Form 10-21085a, b,c,d,e	Prevalence and Clinical Course of Depression Among Patients with Heart Failure	Research_Questionnaire_Booklet1.pdf		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,014

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 Agency Discretion
Annual Number of Responses for this IC	5,014	5,014
Annual IC Time Burden (Hours)	1,362	1,362
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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