Information Collection

IOM Invitation Letter

IC 216590 under ICR 201505-2900-006 · OMB 2900-0842.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 1 Legislation for VA MH study.pdf	Other-Legislation
Att 2_IOM VA MH Services Eval Task 1 Survey - 3-7-16.docx	Other-Invitation Letter
Att 3 Reminder Letter 1 04-27-15.pdf	Other-Reminder Letter
Att 4 Reminder Letter 2 04-27-15.pdf	Other-Reminder Letter
Att 5 Reminder Letter 3 04-27-15.pdf	Other-Reminder Letter
Att 6_IOM VA MH Services Eval Task 1 Survey - Frequently Asked Questions 2-2-16.docx	Other-Frequently Asked Questions
Att 7_IOM VA MH Services Eval Task 1 Survey - Questionnaire 2-2-16.docx	Other-Questionnaire
Att 8 Sampling Overview.pdf	Other-Sampling Overview
Att 9 Data Collection flow.pdf	Other-Data Collection
Att 10 Data Analyses.pdf	Other-Data Analyses
Att 12_Survey COC Certificate.pdf	Other-CoC Certificate
Att 11_IOM VA MH Services Eval Task 1 Survey - Introductory CATI Script 2-2-16.docx	Other-CATI Script

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	Instrument File	Available Electronically?	Electronic Capability
Other-Legislation	Att 1 Legislation for VA MH study.pdf	No	Fillable Printable
Other-Reminder Letter	Att 3 Reminder Letter 1 04-27-15.pdf	No	Fillable Printable
Other-Reminder Letter	Att 4 Reminder Letter 2 04-27-15.pdf	No	Fillable Printable
Other-Reminder Letter	Att 5 Reminder Letter 3 04-27-15.pdf	No	Fillable Printable
Other-Frequently Asked Questions	Att 6_IOM VA MH Services Eval Task 1 Survey - Frequently Asked Questions 2-2-16.docx	No	Fillable Printable
Other-Questionnaire	Att 7_IOM VA MH Services Eval Task 1 Survey - Questionnaire 2-2-16.docx	No	Fillable Printable
Other-Sampling Overview	Att 8 Sampling Overview.pdf	No	Fillable Printable
Other-Data Collection	Att 9 Data Collection flow.pdf	No	Fillable Printable
Other-Data Analyses	Att 10 Data Analyses.pdf	No	Fillable Printable
Other-CoC Certificate	Att 12_Survey COC Certificate.pdf	No	Paper Only
Other-CATI Script	Att 11_IOM VA MH Services Eval Task 1 Survey - Introductory CATI Script 2-2-16.docx	No	Paper Only
Other-Invitation Letter	Att 2_IOM VA MH Services Eval Task 1 Survey - 3-7-16.docx	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 8,900

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	8,900	8,900
Annual IC Time Burden (Hours)	5,192	5,192
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.