Information Collection

Principles of Excellence Complaint Intake Questionnaire

IC 206726 under ICR 201304-2900-036 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 22-0959 Principles of Excellence Complaint Intake Questionnaire	Form
VA Form 22-0959 Principles of Excellence Complaint Intake Questionnaire 22-0959(5-13) (3).pdf www.va.gov/vaforms	Form

IC Title:

Agency IC Tracking Number:

2900-NEW VBA-EDU-NK

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 22-0959	Principles of Excellence Complaint Intake Questionnaire	22-0959(5-13) (3).pdf	www.va.gov/vaforms	Yes	No	Fillable Fileable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records

Title: Principles of Excellence Centralized Complaint System-VA (170VA22)

FR Citation: 77 FR 179

Number of Respondents: 1,200

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	400	400
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.