Information Collection

VSO Access to VHA Electronic Health Record

IC 183126 under ICR 201404-2900-015 · OMB 2900-0710.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-0400 VSO Access to VHA Electronic Health Record	Form and Instruction
10-0400 VSO Access to VHA Electronic Health Records 10-0400-fill_2011_mjm_edits.pdf www.va.gov/vaforms	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 51 38 CFR 52

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 and Instruction	10-0400	VSO Access to VHA Electronic Health Records	10-0400-fill_2011_mjm_edits.pdf	www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Veterans Health Information Systems and Technology Architecture (VistA) Records--VA' (79VA19)

FR Citation: 56 FR 6048

Number of Respondents: 500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	17	17
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.