Information Collection

Spinal Cord Patient Survey; Caregiver Training Participant Feedback; Income Verification Survey; Non-VA Care Vet Survey; Neuro-Rehab Satisfaction Survey

IC 201966 under ICR 201403-2900-007 · OMB 2900-0770.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0770 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-0515 Spinal Cord Patient Survey; Caregiver Training Participant Feedback; Income Verification Survey; Non-VA Care Vet Survey; Neuro-Rehab Satisfaction Survey	Form
Income Verification_Veterans Survey Letter.doc	Other-Survey Cover Letter
Non-VA Care Survey Cover Letter[v2].docx	Other-Survey Cover Letter
VA Form 10-0515 Spinal Cord Injury Patient Survey Spinal Cord Injury Patient Survey_10-0515[v2].doc	Form
VA Form 10-0520 National Family Caregiver Participant Training Feedback National Family Caregiver Participant Training Feedback Form 10-0520 (2).doc URL to be determined by VA	Form
VA Form 10-0541 Survey of Veterans' Satisfaction with Income Verificatio Survey of Veterans' Satisfaction with Income Verification_10-0541[v2].pdf	Form
VA Form 10-0545 Non-VA Care Coordination Veteran Satisfaction Survey Non-VA Care Coord Veteran Satisfaction Survey 10-0545[v2].docx	Form
VA Form 10-0546 Nuerology/Rehabilitation Inpatient Program Satisfaction Neuro Rehab Patient Survey_10-0546[v2].docx	Form
Generic Request_Spinal Cord Injury Patient Care Survey[v2].docx Spinal Cord Injury Patient Care Survey	IC Document
Generic Request_Nat Family Caregiver Training Participant Feedback (2).docx National Family Caregiver Comprehensive Training Program Participant Feedback	IC Document
Generic Request_Vet Satisfaction with Income Verification Svc(v2).docx Survey of Veterans' Satisfaction with the Income Verification Process Service	IC Document
Generic Request_Non-VA Care_Coordination Veterans Satisfaction Survey(v2).docx Non-VA Care Coordination Veteran Satisfaction Survey	IC Document
Generic Request_Neuro Rehabilitation Satisfaction Survey.docx Neurology/Rehabilitation Inpatient Program Satisfaction Survey	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Spinal Cord Patient Survey; Caregiver Training Participant Feedback; Income Verification Survey; Non-VA Care Vet Survey; Neuro-Rehab Satisfaction Survey

Agency IC Tracking Number:

2900-0770

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.9

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 10-0515	Spinal Cord Injury Patient Survey	Spinal Cord Injury Patient Survey_10-0515[v2].doc		No		Paper Only
Form	VA Form 10-0520	National Family Caregiver Participant Training Feedback Form	National Family Caregiver Participant Training Feedback Form 10-0520 (2).doc	URL to be determined by VA	Yes	Yes	Fillable Fileable
Form	VA Form 10-0541	Survey of Veterans' Satisfaction with Income Verification	Survey of Veterans' Satisfaction with Income Verification_10-0541[v2].pdf		No		Paper Only
Form	VA Form 10-0545	Non-VA Care Coordination Veteran Satisfaction Survey	Non-VA Care Coord Veteran Satisfaction Survey 10-0545[v2].docx		No		Paper Only
Form	VA Form 10-0546	Nuerology/Rehabilitation Inpatient Program Satisfaction Survey	Neuro Rehab Patient Survey_10-0546[v2].docx		No		Paper Only
Other-Survey Cover Letter			Income Verification_Veterans Survey Letter.doc		No		Paper Only
Other-Survey Cover Letter			Non-VA Care Survey Cover Letter[v2].docx		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 12,920

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	Previously Approved
Annual Number of Responses for this IC	12,920	12,920
Annual IC Time Burden (Hours)	1,335	1,335
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Spinal Cord Injury Patient Care Survey	Generic Request_Spinal Cord Injury Patient Care Survey[v2].docx	04/23/2012
National Family Caregiver Comprehensive Training Program Participant Feedback	Generic Request_Nat Family Caregiver Training Participant Feedback (2).docx	04/16/2012
Survey of Veterans' Satisfaction with the Income Verification Process Service	Generic Request_Vet Satisfaction with Income Verification Svc(v2).docx	04/23/2012
Non-VA Care Coordination Veteran Satisfaction Survey	Generic Request_Non-VA Care_Coordination Veterans Satisfaction Survey(v2).docx	04/23/2012
Neurology/Rehabilitation Inpatient Program Satisfaction Survey	Generic Request_Neuro Rehabilitation Satisfaction Survey.docx	04/16/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.