Information Collection

Spinal Cord Patient Survey; Caregiver Training Participant Feedback; Income Verification Survey; Non-VA Care Vet Survey; Neuro-Rehab Satisfaction Survey

IC 201966 under ICR 201107-2900-001 · OMB 2900-0770.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0770 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-0515 Spinal Cord Patient Survey; Caregiver Training Participant Feedback; Income Verification Survey; Non-VA Care Vet Survey; Neuro-Rehab Satisfaction Survey	Form
Income Verification_Veterans Survey Letter.doc	Other-Survey Cover Letter
Non-VA Care Survey Cover Letter[v2].docx	Other-Survey Cover Letter
VA Form 10-0515 Spinal Cord Injury Patient Survey Spinal Cord Injury Patient Survey_10-0515[v2].doc	Form
VA Form 10-0520 National Family Caregiver Participant Training Feedback National Family Caregiver Participant Training Feedback Form 10-0520 (2).doc URL to be determined by VA	Form
VA Form 10-0541 Survey of Veterans' Satisfaction with Income Verificatio Survey of Veterans' Satisfaction with Income Verification_10-0541[v2].pdf	Form
VA Form 10-0545 Non-VA Care Coordination Veteran Satisfaction Survey Non-VA Care Coord Veteran Satisfaction Survey 10-0545[v2].docx	Form
VA Form 10-0546 Nuerology/Rehabilitation Inpatient Program Satisfaction Neuro Rehab Patient Survey_10-0546[v2].docx	Form
Generic Request_Spinal Cord Injury Patient Care Survey[v2].docx Spinal Cord Injury Patient Care Survey	IC Document
Generic Request_Nat Family Caregiver Training Participant Feedback (2).docx National Family Caregiver Comprehensive Training Program Participant Feedback	IC Document
Generic Request_Vet Satisfaction with Income Verification Svc(v2).docx Survey of Veterans' Satisfaction with the Income Verification Process Service	IC Document
Generic Request_Non-VA Care_Coordination Veterans Satisfaction Survey(v2).docx Non-VA Care Coordination Veteran Satisfaction Survey	IC Document
Generic Request_Neuro Rehabilitation Satisfaction Survey.docx Neurology/Rehabilitation Inpatient Program Satisfaction Survey	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Spinal Cord Patient Survey; Caregiver Training Participant Feedback; Income Verification Survey; Non-VA Care Vet Survey; Neuro-Rehab Satisfaction Survey

Agency IC Tracking Number:

2900-0770

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.9

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 10-0515	Spinal Cord Injury Patient Survey	Spinal Cord Injury Patient Survey_10-0515[v2].doc		No		Paper Only
Form	VA Form 10-0520	National Family Caregiver Participant Training Feedback Form	National Family Caregiver Participant Training Feedback Form 10-0520 (2).doc	URL to be determined by VA	Yes	Yes	Fillable Fileable
Form	VA Form 10-0541	Survey of Veterans' Satisfaction with Income Verification	Survey of Veterans' Satisfaction with Income Verification_10-0541[v2].pdf		No		Paper Only
Form	VA Form 10-0545	Non-VA Care Coordination Veteran Satisfaction Survey	Non-VA Care Coord Veteran Satisfaction Survey 10-0545[v2].docx		No		Paper Only
Form	VA Form 10-0546	Nuerology/Rehabilitation Inpatient Program Satisfaction Survey	Neuro Rehab Patient Survey_10-0546[v2].docx		No		Paper Only
Other-Survey Cover Letter			Income Verification_Veterans Survey Letter.doc		No		Paper Only
Other-Survey Cover Letter			Non-VA Care Survey Cover Letter[v2].docx		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: 12,920

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12,920	12,920
Annual IC Time Burden (Hours)	1,335	1,335
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Spinal Cord Injury Patient Care Survey	Generic Request_Spinal Cord Injury Patient Care Survey[v2].docx	04/23/2012
National Family Caregiver Comprehensive Training Program Participant Feedback	Generic Request_Nat Family Caregiver Training Participant Feedback (2).docx	04/16/2012
Survey of Veterans' Satisfaction with the Income Verification Process Service	Generic Request_Vet Satisfaction with Income Verification Svc(v2).docx	04/23/2012
Non-VA Care Coordination Veteran Satisfaction Survey	Generic Request_Non-VA Care_Coordination Veterans Satisfaction Survey(v2).docx	04/23/2012
Neurology/Rehabilitation Inpatient Program Satisfaction Survey	Generic Request_Neuro Rehabilitation Satisfaction Survey.docx	04/16/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.