Information Collection

HEC New Enrollee Survey

IC 191196 under ICR 201008-2900-001 · OMB 2900-0758.

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

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 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

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.