Information Collection

A Veteran's Faith: Spirituality Influences Coping with Cancer

IC 188210 under ICR 200903-2900-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA form 10-21093(A A Veteran's Faith: Spirituality Influences Coping with Cancer	Form
VA form 10-21093(A A Veterans Faith: Spirituality Influences Coping with Ca Demographic Data Sheet.doc	Form
VA Form 10-21093(B A Veterans Faith: Spirituality Influences Coping with Ca SBI-15R Questionnaire.doc	Form and Instruction
VA Form 10-21093(C A Veterans Faith: Spirituality Influences Coping with Ca PG-12 Questionnaire.doc	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	Available Electronically?	Electronic Capability
Form	VA form 10-21093(A)	A Veterans Faith: Spirituality Influences Coping with Cancer - Demographic Data	Demographic Data Sheet.doc	No	Paper Only
Form and Instruction	VA Form 10-21093(B)	A Veterans Faith: Spirituality Influences Coping with Cancer - Spiritual Beliefs Inventory	SBI-15R Questionnaire.doc	No	Paper Only
Form and Instruction	VA Form 10-21093(C)	A Veterans Faith: Spirituality Influences Coping with Cancer - Prolonged Grief Scale	PG-12 Questionnaire.doc	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40	40
Annual IC Time Burden (Hours)	10	10
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.