Information Collection

Survey of Chronic Gastrointestinal Illness inPersian Gulf Veterans (Irritaable Bowel syndrome - Diarrhea)

IC 188135 under ICR 200902-2900-012 · OMB 2900-0742.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0742 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 10-21092c Survey of Chronic Gastrointestinal Illness inPersian Gulf Veterans (Irritaable Bowel syndrome - Diarrhea) Form and Instruction
VA Form 10-21092c Survey of Chronic Gastrointestinal Illness in Persian Gu IBS PG Veterans' Survey.pdf To Be Determined Form and Instruction
VA Form 10-21092A Patient Consent Form - Cases Study VA Form 10-21092a (Case).doc Form and Instruction
VA Form 10-21092B Patient Consent Form - Controls Study VA Form 10-21092b (Control).doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Survey of Chronic Gastrointestinal Illness inPersian Gulf Veterans (Irritaable Bowel syndrome - Diarrhea)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	VA Form 10-21092c	Survey of Chronic Gastrointestinal Illness in Persian Gulf Veterans	IBS PG Veterans' Survey.pdf	To Be Determined	Yes	No	Fillable Printable
Form and Instruction	VA Form 10-21092A	Patient Consent Form - Cases Study	VA Form 10-21092a (Case).doc		No		Paper Only
Form and Instruction	VA Form 10-21092B	Patient Consent Form - Controls Study	VA Form 10-21092b (Control).doc		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Veteran, Patient, Employee and Volunteer Research and Development Project Records-VA (34VA12)	FR Citation: 45 FR 160

Number of Respondents: 4,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,000	4,000
Annual IC Time Burden (Hours)	3,072	3,072
Annual IC Cost Burden (Dollars)	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.