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HEC New Enrollee Survey
Health Eligibility Center (HEC) New Enrollee Survey
OMB: 2900-0758
IC ID: 191196
OMB.report
VA
OMB 2900-0758
ICR 201008-2900-001
IC 191196
( )
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
HEC New Enrollee Survey
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Unchanged
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 10-0479
Health Eligibility Center (HEC) New Enrollee Survey
HEC New Enrollee Survey.pdf
No
Paper Only
Federal Enterprise Architecture Business Reference Module
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 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,614
0
1,614
0
0
0
Annual IC Time Burden (Hours)
153
0
153
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.
