Information Collection

288 VHA Outpatient 289 VHA Inpatient 290 Rural Dev

IC 191711 under ICR 200908-1090-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 288 CFI 2009 VHA Outpatient 288 VHA Outpatient 289 VHA Inpatient 290 Rural Dev	Form
Form 289 CFI 2009 VHA Inpatient 288 VHA Outpatient 289 VHA Inpatient 290 Rural Dev	Form
Form 290 CFI 2010 Rural Development 288 VHA Outpatient 289 VHA Inpatient 290 Rural Dev	Form
288 CFI 2009 VHA Outpatient 2009 VHA Outpatient Survey 1-6-10.doc	Form
289 CFI 2009 VHA Inpatient 2009 VHA Inpatient Survey1-6-10.doc	Form
290 CFI 2010 Rural Development 2010 USDA Rural Development Questionnaire Final Version Jan 7 2010.doc	Form

IC Title:

288 VHA Outpatient 289 VHA Inpatient 290 Rural Dev

Agency IC Tracking Number:

288 CFI

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?	Can Be Submitted Electronically?	Electronic Capability
Form	288 CFI	2009 VHA Outpatient	2009 VHA Outpatient Survey 1-6-10.doc	No		Paper Only
Form	289 CFI	2009 VHA Inpatient	2009 VHA Inpatient Survey1-6-10.doc	No		Paper Only
Form	290 CFI	2010 Rural Development	2010 USDA Rural Development Questionnaire Final Version Jan 7 2010.doc	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 750

Number of Respondents for Small Entity: 250

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 33 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	150	150
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.