Information Collection

VSO Access to VHA Electronic Health Record

IC 183126 under ICR 200805-2900-016 · OMB 2900-0710.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0710 can be found here:

Documents and Forms

Document Name Document Type
Form 10-0400 VSO Access to VHA Electronic Health Record Form and Instruction
10-0400 VSO Access to VHA Electronic Health Records VSOUser_AccessRequestForm.pdf www.va.gov/vaforms Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	VSO Access to VHA Electronic Health Record	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 51 38 CFR 52

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10-0400	VSO Access to VHA Electronic Health Records	VSOUser_AccessRequestForm.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Veterans Health Information Systems and Technology Architecture (VistA) Records--VA' (79VA19)	FR Citation: 69 FR 24

Number of Respondents: 12,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	12,000	11,920	80
Annual IC Time Burden (Hours)	400	397	3
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.