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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 288 CFI 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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.