Information Collection

Veterans' Suicide Prevention Online Quantitative Surveys

IC 195895 under ICR 201101-2900-007 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-0513 Veterans' Suicide Prevention Online Quantitative Surveys	Form
VA Form 10-0513 Veterans' Online Survey Veterans' Online Survey_10-0513.pdf TBD by Contractor	Form
VA Form 10-0513A Veterans' Family Members Online Survey Veterans' Family Members Online Survey_10-0513A.pdf TBD by Contractor	Form
VA Form 10-0513B Health Care Providers Online Survey Health Care Providers Online Survey_10-0513B.pdf TBD by Contractor	Form

IC Title:

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 10-0513	Veterans' Online Survey	Veterans' Online Survey_10-0513.pdf	TBD by Contractor	Yes	Yes	Fillable Fileable
Form	VA Form 10-0513A	Veterans' Family Members Online Survey	Veterans' Family Members Online Survey_10-0513A.pdf	TBD by Contractor	Yes	Yes	Fillable Fileable
Form	VA Form 10-0513B	Health Care Providers Online Survey	Health Care Providers Online Survey_10-0513B.pdf	TBD by Contractor	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,800

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	1,800	1,800
Annual IC Time Burden (Hours)	900	900
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.