Information Collection

Veterans Health Administration One Year Post-Exit Survey Pilot Study

IC 199714 under ICR 201110-2900-007 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-0478 Veterans Health Administration One Year Post-Exit Survey Pilot Study	Form
VA Form 10-0478 VHA Post-Exit 1 Year Pilot Survey Study Post-Exit Pilot Study Survey Questions (2).doc To Be Determined	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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 10-0478	VHA Post-Exit 1 Year Pilot Survey Study	Post-Exit Pilot Study Survey Questions (2).doc	To Be Determined	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Personnel

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,290

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,290	1,290
Annual IC Time Burden (Hours)	323	323
Annual IC Cost Burden (Dollars)	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.