Prevalence and Clinical Course of Depression Among Patients with Heart Failure, VA HSR&D, Nursing Research Initiative No. 05-209-3

Documents and Forms

Document Name Document Type
Form VA Form 10-21085a, Prevalence and Clinical Course of Depression Among Patients with Heart Failure, VA HSR&D, Nursing Research Initiative No. 05-209-3 Form and Instruction
VA Form 10-21085a, Prevalence and Clinical Course of Depression Among Patie Research_Questionnaire_Booklet1.pdf Form and Instruction

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IC Title:	Prevalence and Clinical Course of Depression Among Patients with Heart Failure, VA HSR&D, Nursing Research Initiative No. 05-209-3	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	VA Form 10-21085a, b,c,d,e	Prevalence and Clinical Course of Depression Among Patients with Heart Failure	Research_Questionnaire_Booklet1.pdf		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

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Number of Respondents: 5,014	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	5,014	5,014
Annual IC Time Burden (Hours)	1,362	1,362
Annual IC Cost Burden (Dollars)	0	0

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