Information Collection

Ethics Consultation Feedback Tool

IC 192020 under ICR 201304-2900-006 · OMB 2900-0750.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0750 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 10-10065 Ethics Consultation Feedback Tool Form
VA Form 10-10065 Ethics Consultation Feedback Tool VA Form 10-10065_Ethics.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Ethics Consultation Feedback Tool	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	VA Form 10-10065	Ethics Consultation Feedback Tool	VA Form 10-10065_Ethics.pdf	ECWeb	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 204	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	204	-996	1,200
Annual IC Time Burden (Hours)	17	-83	100
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.