OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

541 Alzheimer's Questionnaire - 561 VA-eBenefits Questionnaire

IC 204134 under ICR 201110-1090-001 · OMB 1090-0008.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 541
541 Alzheimer's Questionnaire - 561 VA-eBenefits Questionnaire		 Form and Instruction
543 543 Cahaba J10 MAC Survey
2012 543 Cahaba J10 MAC Survey 8.28.2012_UPDATED.xlsx 		Form and Instruction
544 544 CMS Novitas JH MAC
2012 544 CMS - Novitas JH MAC 8-13-12_DOT.xlsx 		Form and Instruction
545 545 CMS Cahaba J10 MAC
2012 545 CMS Cahaba J10 MAC 6-25-12.xlsx 		Form and Instruction
546 546 CMS WPS J8 MAC Questionnaire
2012 546 CMS WPS- J8 MAC Questionnaire 7-19-2012.xlsx 		Form and Instruction
547 547 CQs for OMB started 6-7-2012
2012 547 CQs for OMB started 6-7-2012.xlsx 		Form and Instruction
548 548 CVC Tour 8-21-12
2012 548 CVC Tour 8-21-12_DOT.xlsx 		Form and Instruction
549 549 Dept of State v2 8-17-12
2012 549 Dept of State v2 8-17-12_DOT.xlsx 		Form and Instruction
550 550 DHHS PSC Offline v2 8-13-12
2012 550 DHHS - PSC Offline v2 8-13-12.xlsx 		Form and Instruction
551 551 DOJ ATF 7-24-12
2012 551 DOJ ATF 7-24-12.xlsx 		Form and Instruction
552 552 DOL Doors August 2012
2012 552 DOL Doors August 2012 8-9-12_DOT.xlsx 		Form and Instruction
553 553 FDA Browse 6-27-12
2012 553 FDA Browse 6-27-12.xlsx 		Form and Instruction
554 554 NHTSA 6.27.12
2012 554 NHTSA 6-27-12.xlsx 		Form and Instruction
555 555 NHTSA 8.27.12 DOT
2012 555 NHTSA 8-27-12_DOT.xlsx 		Form and Instruction
556 556 NIJ NIJ v2 9-1-12
2012 556 NIJ_NIJ+v2+8-01-12.xlsx 		Form and Instruction
557 557 PBGC.gov v3 Questionnaire 8-15-12
2012 557 PBGC.gov v3 Questionnaire 8-15-2012_DOT.xlsx 		Form and Instruction
558 558 PBGC Perception Questionnaire
2012 558 PBGC-Perception Qnaire 8-15-12_DOT.xlsx 		Form and Instruction
559 559 Recreation.gov Questionnaire 8-28-12
2012 559 recreation.gov Qnaire 8-28-12_DOT.xlsx 		Form and Instruction
560 560 SaferCar Questionnaire June 2012
2012 560 SaferCar Questionnaire June 19 2012.xlsx 		Form and Instruction
561 561 VA eBenefits Questionnaire 8-29-12
2012 561 VA-eBenefits Questionnaire 8-29-12_DOT.xlsx 		Form and Instruction
541 541 Alzheimers Questionaire
2012 541 Alzheimer's Questionaire July 2012cRev10.1.12.xlsx 		Form and Instruction
542 Alzheimers AOA
2012 542 AOA Alzheimers.gov Rev10.1-12.xlsx 		Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 and Instruction 541 541 Alzheimers Questionaire 2012 541 Alzheimer's Questionaire July 2012cRev10.1.12.xlsx Yes Yes Fillable Fileable
Form and Instruction 543 543 Cahaba J10 MAC Survey 2012 543 Cahaba J10 MAC Survey 8.28.2012_UPDATED.xlsx Yes Yes Fillable Fileable
Form and Instruction 544 544 CMS Novitas JH MAC 2012 544 CMS - Novitas JH MAC 8-13-12_DOT.xlsx Yes Yes Fillable Fileable
Form and Instruction 545 545 CMS Cahaba J10 MAC 2012 545 CMS Cahaba J10 MAC 6-25-12.xlsx Yes Yes Fillable Fileable
Form and Instruction 546 546 CMS WPS J8 MAC Questionnaire 2012 546 CMS WPS- J8 MAC Questionnaire 7-19-2012.xlsx Yes Yes Fillable Fileable
Form and Instruction 547 547 CQs for OMB started 6-7-2012 2012 547 CQs for OMB started 6-7-2012.xlsx Yes Yes Fillable Fileable
Form and Instruction 548 548 CVC Tour 8-21-12 2012 548 CVC Tour 8-21-12_DOT.xlsx Yes Yes Fillable Fileable
Form and Instruction 549 549 Dept of State v2 8-17-12 2012 549 Dept of State v2 8-17-12_DOT.xlsx Yes Yes Fillable Fileable
Form and Instruction 550 550 DHHS PSC Offline v2 8-13-12 2012 550 DHHS - PSC Offline v2 8-13-12.xlsx Yes Yes Fillable Fileable
Form and Instruction 551 551 DOJ ATF 7-24-12 2012 551 DOJ ATF 7-24-12.xlsx Yes Yes Fillable Fileable
Form and Instruction 552 552 DOL Doors August 2012 2012 552 DOL Doors August 2012 8-9-12_DOT.xlsx Yes Yes Fillable Fileable
Form and Instruction 553 553 FDA Browse 6-27-12 2012 553 FDA Browse 6-27-12.xlsx Yes Yes Fillable Fileable
Form and Instruction 554 554 NHTSA 6.27.12 2012 554 NHTSA 6-27-12.xlsx Yes Yes Fillable Fileable
Form and Instruction 555 555 NHTSA 8.27.12 DOT 2012 555 NHTSA 8-27-12_DOT.xlsx Yes Yes Fillable Fileable
Form and Instruction 556 556 NIJ NIJ v2 9-1-12 2012 556 NIJ_NIJ+v2+8-01-12.xlsx Yes Yes Fillable Fileable
Form and Instruction 557 557 PBGC.gov v3 Questionnaire 8-15-12 2012 557 PBGC.gov v3 Questionnaire 8-15-2012_DOT.xlsx Yes Yes Fillable Fileable
Form and Instruction 558 558 PBGC Perception Questionnaire 2012 558 PBGC-Perception Qnaire 8-15-12_DOT.xlsx Yes Yes Fillable Fileable
Form and Instruction 559 559 Recreation.gov Questionnaire 8-28-12 2012 559 recreation.gov Qnaire 8-28-12_DOT.xlsx Yes Yes Fillable Fileable
Form and Instruction 560 560 SaferCar Questionnaire June 2012 2012 560 SaferCar Questionnaire June 19 2012.xlsx Yes Yes Fillable Fileable
Form and Instruction 561 561 VA eBenefits Questionnaire 8-29-12 2012 561 VA-eBenefits Questionnaire 8-29-12_DOT.xlsx Yes Yes Fillable Fileable
Form and Instruction 542 Alzheimers AOA 2012 542 AOA Alzheimers.gov Rev10.1-12.xlsx Yes Yes Fillable Fileable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 75,600 0 75,600 0 0 0
Annual IC Time Burden (Hours) 3,150 0 3,150 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 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.