Information Collection

uSPEQ® Consumer Experience Survey (Rehabilitation)

IC 187874 under ICR 201611-2900-012 · OMB 2900-0752.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0752 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 10-0467 uSPEQ® Consumer Experience Survey (Rehabilitation) Form
VA Form 10-0467 uSPEQ Consumer Experience Survey (Rehabilitation) uSPEQ Survey (09).pdf To Be Determined Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	uSPEQÂ® Consumer Experience Survey (Rehabilitation)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

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	VA Form 10-0467	uSPEQ Consumer Experience Survey (Rehabilitation)	uSPEQ Survey (09).pdf	To Be Determined	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 384,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	384,000	384,000
Annual IC Time Burden (Hours)	32,000	32,000
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.