Information Collection

VA Cooperative Studies Program (CSP) Customer Satisfaction Survey

IC 211036 under ICR 201709-2900-017 · OMB 2900-0772.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-10074 VA Cooperative Studies Program (CSP) Customer Satisfaction Survey	Form and Instruction
10-10074 CSP Customer Satisfaction Survey CSP_Customer Satisfaction Survey_092717.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

2900-0772

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

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
Form and Instruction	10-10074	CSP Customer Satisfaction Survey	CSP_Customer Satisfaction Survey_092717.docx		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 500

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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	83	83
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.