Information Collection

38 CFR 77 Report Template

IC 215773 under ICR 201501-2900-009 · OMB 2900-0845.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
FY15 ASG Quarterly Report - Template.xlsx Quarterly Reporting Measure	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 38 CFR 77

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

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title: Department of Veterans Affairs

FR Citation: 66 FR 63426

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,050	1,050
Annual IC Time Burden (Hours)	2,100	2,100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Quarterly Reporting Measure	FY15 ASG Quarterly Report - Template.xlsx	02/11/2016

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