Information Collection

Rehabilitation Care Survey/HEC Vet Enrollment Survey/Project ARCH non-sub change

IC 209046 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⚠️ Notice: This information collection may be referencing outdated material.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 10-211010 Rehabilitation Care Survey/HEC Vet Enrollment Survey/Project ARCH non-sub change	Form
VA Form 10-211010 Survey of Rehabilitation Care Survey Form 10-211010_RCS_Rehab Care Survey.docx	Form
VA Form 10-211013 HEC Enrollment Survey HEC Enrollment Survey 10-211013.pdf To Be Determined	Form
VA Form 10-211004 Project ARCH Non-Participant Survey Project ARCH Non-Participant Survey 10-211004 (8-2013).pdf	Form
Generic Survey Request_RehabCare.docx Survey of Rehabilitation Healthcare Services	IC Document
Generic_Request_HEC Enrollment Survey.docx HEC Enrollment Survey	IC Document
OMB Memo for Project ARCH Survey Minor Change.pdf Memo Request for 2900-0770 Project ARCH (Non-Participant survey) Non-substantive change	IC Document

IC Title:

Rehabilitation Care Survey/HEC Vet Enrollment Survey/Project ARCH non-sub change

Agency IC Tracking Number:

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 10-211010	Survey of Rehabilitation Care Survey	Form 10-211010_RCS_Rehab Care Survey.docx		No		Paper Only
Form	VA Form 10-211013	HEC Enrollment Survey	HEC Enrollment Survey 10-211013.pdf	To Be Determined	Yes	Yes	Fillable Fileable
Form	VA Form 10-211004	Project ARCH Non-Participant Survey	Project ARCH Non-Participant Survey 10-211004 (8-2013).pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,155

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	1,328	1,328
Annual IC Time Burden (Hours)	271	271
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Survey of Rehabilitation Healthcare Services	Generic Survey Request_RehabCare.docx	10/27/2013
HEC Enrollment Survey	Generic_Request_HEC Enrollment Survey.docx	10/27/2013
Memo Request for 2900-0770 Project ARCH (Non-Participant survey) Non-substantive change	OMB Memo for Project ARCH Survey Minor Change.pdf	11/12/2013

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