VA Preparedness Survey

VA Preparedness Communications Survey

Documents and Forms

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

Information Collection (IC) Details

IC Title:	VA Preparedness Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.