Information Collection

Survey of Veteran Enrollees Quality and Efficiency of VA Health Care

IC 185562 under ICR 200807-2900-001 · OMB 2900-0725.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-21088 Survey of Veteran Enrollees Quality and Efficiency of VA Health Care	Form and Instruction
VA Form 10-21088 Survey of Veteran Enrollees - Quality and Efficiency of Survey 10-21088.pdf To Be Determined	Form and Instruction

IC Title:

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 10-21088	Survey of Veteran Enrollees - Quality and Efficiency of VA Health Care	Survey 10-21088.pdf	To Be Determined	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 80,080

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	80,080	80,080
Annual IC Time Burden (Hours)	18,133	18,133
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.