Information Collection

Health Eligibility Center (HEC) Correspondence Satisfaction Letter and Customer Modality Survey

IC 189770 under ICR 201308-2900-012 · OMB 2900-0761.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-0151 Health Eligibility Center (HEC) Correspondence Satisfaction Letter and Customer Modality Survey	Form
VA Form 10-0151 Customer Modality Administrative Survey VA form 10-0151.pdf To Be Determined	Form
VA Form 10-211007 HEC Online Survey HEC_Online_Survey 2.pdf To Be Determined	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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 10-0151	Customer Modality Administrative Survey	VA form 10-0151.pdf	To Be Determined	Yes	Yes	Fillable Fileable
Form	VA Form 10-211007	HEC Online Survey	HEC_Online_Survey 2.pdf	To Be Determined	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 222,740

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	383,301	383,301
Annual IC Time Burden (Hours)	94,678	94,678
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.