Veteran Survey

Veterans Health Administration Homeless Programs - Project Chaleng (Community Homelessness Assessment, Local Education and Networking Groups) for Veterans

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0843 can be found here:

Documents and Forms

Document Name Document Type
Form 10-10161 Veteran Survey Form and Instruction
10-10161 Veteran Assessment Veteran Assessment 102315.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Veteran 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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10-10161	Veteran Assessment	Veteran Assessment 102315.pdf		No		Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,000	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	7,000	7,000
Annual IC Time Burden (Hours)	583	583
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.