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Federal forms, ICRs, and supporting documents

Information Collection

Food and Nutrition Survey/Fraud,Waste,Abuse Complaint/Epilepsy Satisf-Survey/Building Better Caregivers Survey/Sodium Dichromate Feedback Survey

IC 205547 under ICR 201403-2900-007 · OMB 2900-0770.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
Form and Instruction
Form
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Food and Nutrition Survey/Fraud,Waste,Abuse Complaint/Epilepsy Satisf-Survey/Building Better Caregivers Survey/Sodium Dichromate Feedback Survey
 
Modified
 
Voluntary
 
5 CFR 1320.8(d)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 10-0498 Food and Nutrition Satisfaction Survey Food and Nutrition Survey_10-0498.pdf No   Paper Only
Form VA Form 10-0500 Fraud, Waste and Abuse Complaint Form Fraud Complaint Form_10-0500.pdf To Be Determined Yes Yes Fillable Fileable
Form VA Form 10-0558 Epilepsy Centers of Excellence (ECoE) Patient Satisfaction Survey ECoE Patient Satisfaction Survey_10-0558.pdf To Be Determined Yes Yes Fillable Fileable
Form and Instruction VA Form 10-0499 Building Better Caregivers Satisfaction Survey BuildBetterCaregivers - 10-0499 Survey.pdf.pdf Follow up Telephone Script No   Fillable Printable
Form VA Form 10-0559 Sodium Dichromate Exposure Exam Feedback Survey Survey Feedback_Sodium Dichromate Exam 10-0559.pdf No   Paper Only

Health Health Care Services

 

129,980 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 129,980 0 0 0 0 129,980
Annual IC Time Burden (Hours) 4,941 0 0 0 0 4,941
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Food and Nutrition Satisfaction Survey Food and Nutrition Survey_Generic_Submission_2012.docx 01/27/2013
Fraud, Waste, and Abuse Complaint Form Fraud Complaint Form Generic Request_v2_.docx 01/27/2013
Epilepsy Centers of Excellence (ECoE) Satisfaction Survey Generic Submission - ECoE Patient Satisfaction Survey (2).docx 01/27/2013
Building Better Caregivers Satisfaction Survey BuildBetterCaregiver Generic_Submission (v4).docx 01/27/2013
Sodium Dichromate Exposure Exam Feedback Sodium Dichromate Exposure Survey_Generic_Request.docx 01/27/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.