Information Collection

Millennium Bill Emergency Care Provider Satisfaction Survey

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

Documents and Forms

Documents and forms in this information collection
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

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	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 %

table that charts list of burden
	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

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.