Information Collection

Rehabilitation Care Survey/HEC Vet Enrollment Survey/Project ARCH non-sub change

IC 209046 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⚠️ Notice: This information collection may be referencing outdated material.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 10-211010 Rehabilitation Care Survey/HEC Vet Enrollment Survey/Project ARCH non-sub change	Form
VA Form 10-211010 Survey of Rehabilitation Care Survey Form 10-211010_RCS_Rehab Care Survey.docx	Form
VA Form 10-211013 HEC Enrollment Survey HEC Enrollment Survey 10-211013.pdf To Be Determined	Form
VA Form 10-211004 Project ARCH Non-Participant Survey Project ARCH Non-Participant Survey 10-211004 (8-2013).pdf	Form
Generic Survey Request_RehabCare.docx Survey of Rehabilitation Healthcare Services	IC Document
Generic_Request_HEC Enrollment Survey.docx HEC Enrollment Survey	IC Document
OMB Memo for Project ARCH Survey Minor Change.pdf Memo Request for 2900-0770 Project ARCH (Non-Participant survey) Non-substantive change	IC Document

IC Title:

Rehabilitation Care Survey/HEC Vet Enrollment Survey/Project ARCH non-sub change

Agency IC Tracking Number:

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 10-211010	Survey of Rehabilitation Care Survey	Form 10-211010_RCS_Rehab Care Survey.docx		No		Paper Only
Form	VA Form 10-211013	HEC Enrollment Survey	HEC Enrollment Survey 10-211013.pdf	To Be Determined	Yes	Yes	Fillable Fileable
Form	VA Form 10-211004	Project ARCH Non-Participant Survey	Project ARCH Non-Participant Survey 10-211004 (8-2013).pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,155

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	1,328	1,328
Annual IC Time Burden (Hours)	271	271
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Survey of Rehabilitation Healthcare Services	Generic Survey Request_RehabCare.docx	10/27/2013
HEC Enrollment Survey	Generic_Request_HEC Enrollment Survey.docx	10/27/2013
Memo Request for 2900-0770 Project ARCH (Non-Participant survey) Non-substantive change	OMB Memo for Project ARCH Survey Minor Change.pdf	11/12/2013

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