Information Collection

CFI 141 USDA NASS, CFI 142 VA Outpatient, CFI 143 VA Inpatient

IC 182649 under ICR 200904-1090-001 · OMB 1090-0007.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0007 can be found here:

Documents and Forms

Document Name Document Type
Form CFI 141 CFI 141 USDA NASS, CFI 142 VA Outpatient, CFI 143 VA Inpatient Form
CFI 141 USDA NASS questionnaire CFI 141 USDA NASS.doc Form
CFI 142 VA Outpatient Questionnaire CFI 142 VA Outpatient Questionnaire.doc Form
CFI 143 VA Inpatient questionnaire CFI 143 VA Inpatient Questionnaire.doc Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	CFI 141 USDA NASS, CFI 142 VA Outpatient, CFI 143 VA Inpatient	Agency IC Tracking Number:	CFI 141, CFI 142, CFI 143

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	CFI 141	USDA NASS questionnaire	CFI 141 USDA NASS.doc	No	Paper Only
Form	CFI 142	VA Outpatient Questionnaire	CFI 142 VA Outpatient Questionnaire.doc	No	Paper Only
Form	CFI 143	VA Inpatient questionnaire	CFI 143 VA Inpatient Questionnaire.doc	No	Paper Only

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 780	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	780	0	0	0	0	0
Annual IC Time Burden (Hours)	156	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	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.