Information Collection

Survey of Veteran Enrollees' Health and Reliance Upon VA

IC 28855 under ICR 201107-2900-029 · OMB 2900-0609.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0609 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-21034G Survey of Veteran Enrollees' Health and Reliance Upon VA	Form
VA Form 10-21034G (CATI) Survey of Veteran Enrollees VA Form 10-21034g_SoE2012_11-2011.doc	Form

IC Title:

Survey of Veteran Enrollees' Health and Reliance Upon VA

Agency IC Tracking Number:

2900-0609

Is this a Common Form? No

IC Status: Modified

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 10-21034G	(CATI) Survey of Veteran Enrollees	VA Form 10-21034g_SoE2012_11-2011.doc		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 42,200

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	42,200	120	42,080
Annual IC Time Burden (Hours)	14,400	0	14,400
Annual IC Cost Burden (Dollars)	0	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.