Information Collection

2016 788 VHA_Inpatient 2016 Survey

IC 223602 under ICR 201412-1090-003 · OMB 1090-0007.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0007 can be found here:

Documents and Forms

Document Name Document Type
Form 788 2016 788 VHA_Inpatient 2016 Survey Form
788 2016 788 VHA_Inpatient 2016 Survey 2016 788 VHA_Inpatient 2016 Survey.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	2016 788 VHA_Inpatient 2016 Survey	Agency IC Tracking Number:	788

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	788	2016 788 VHA_Inpatient 2016 Survey	2016 788 VHA_Inpatient 2016 Survey.docx		Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	50	50
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.