Information Collection

VA Preparedness Survey

IC 213369 under ICR 201410-2900-003 · OMB 2900-0833.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
3_Group 1 second contact letter.docx	Instruction
7_Group 1 cash token for completion letter.docx	Instruction
8_Group 2 first contact letter.docx	Instruction
10_Group 2 second contact letter.docx	Instruction
14_Group 2 cash token for completion letter.docx	Instruction
15_Group 3 contact letter.docx	Instruction
20_Group 3 cash token for completion letter.docx	Instruction
10-0528 Group 5 web survey 5_Group 1 web survey.docx	Form and Instruction
10-0208 Group 6 CATI Survey 6_Group 1 CATI survey.docx	Form and Instruction
10-0485 Group 2 Print Survey 11_Group 2 print survey.pdf	Form and Instruction
10-0485 Group 12 Survey 12_Group 2 web survey.docx	Form and Instruction
10-0485 Group 13 CATI Survey 13_Group 2 CATI survey.docx	Form and Instruction
10-0485 Group 19 CATI Survey 19_Group 3 CATI survey.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			3_Group 1 second contact letter.docx	No		Fillable Printable
Form and Instruction	10-0528	Group 5 web survey	5_Group 1 web survey.docx	No		Fillable Printable
Form and Instruction	10-0208	Group 6 CATI Survey	6_Group 1 CATI survey.docx	No		Fillable Printable
Instruction			7_Group 1 cash token for completion letter.docx	No		Fillable Printable
Instruction			8_Group 2 first contact letter.docx	No		Fillable Printable
Instruction			10_Group 2 second contact letter.docx	No		Fillable Printable
Form and Instruction	10-0485	Group 2 Print Survey	11_Group 2 print survey.pdf	No		Fillable Printable
Form and Instruction	10-0485	Group 12 Survey	12_Group 2 web survey.docx	Yes	Yes	Fillable Printable
Form and Instruction	10-0485	Group 13 CATI Survey	13_Group 2 CATI survey.docx	No		Fillable Printable
Instruction			14_Group 2 cash token for completion letter.docx	No		Fillable Printable
Instruction			15_Group 3 contact letter.docx	No		Fillable Printable
Form and Instruction	10-0485	Group 19 CATI Survey	19_Group 3 CATI survey.docx	No		Fillable Printable
Instruction			20_Group 3 cash token for completion letter.docx	No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,272

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,272	2,272
Annual IC Time Burden (Hours)	379	379
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.