Information Collection

HEC New Enrollee Survey

IC 191196 under ICR 200911-2900-005 · OMB 2900-0758.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0758 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-0479 HEC New Enrollee Survey	Form
VA Form 10-0479 Health Eligibility Center (HEC) New Enrollee Survey HEC New Enrollee Survey.pdf	Form

IC Title:

HEC New Enrollee Survey

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 10-0479	Health Eligibility Center (HEC) New Enrollee Survey	HEC New Enrollee Survey.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,055

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,614	1,614
Annual IC Time Burden (Hours)	153	153
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.