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

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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Health Eligibility Center (HEC) Correspondence Satisfaction Letter and Customer Modality Survey	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 10-0151	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 %

	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

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.