Information Collection

Millennium Bill Emergency Care Provider Satisfaction Survey

IC 190127 under ICR 200907-2900-010 · OMB 2900-0763.

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

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 Agency Discretion
Annual Number of Responses for this IC	110	110
Annual IC Time Burden (Hours)	9	9
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.