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Millennium Bill Emergency Care Provider Satisfaction Survey
Millennium Bill Emergency Care Provider Satisfaction Survey
OMB: 2900-0763
IC ID: 190127
OMB.report
VA
OMB 2900-0763
ICR 200907-2900-010
IC 190127
( )
Documents and Forms
Document Name
Document Type
Form VA Form 10-0473
Millennium Bill Emergency Care Provider Satisfaction Survey
Form
VA Form 10-0473 Millennium Bill Emergency Care Provider Satisfaction Sur
VA Form 10-0473.pdf
To Be Determined
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Millennium Bill Emergency Care Provider Satisfaction Survey
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
VA Form 10-0473
Millennium Bill Emergency Care Provider Satisfaction Survey
VA Form 10-0473.pdf
To Be Determined
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
110
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
110
0
110
0
0
0
Annual IC Time Burden (Hours)
9
0
9
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.
