Information Collection

Income Verification Survey

IC 229475 under ICR 201710-2900-001 · OMB 2900-0770.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0770 can be found here:

Documents and Forms

Document Name Document Type
New IVD package 2017.pdf Other-Survey
VA Generic Fast-Track Clearance Request IVD Survey 2017.docx IVD Generic Request IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Income Verification Survey	Agency IC Tracking Number:	2900-0770

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
Other-Survey			New IVD package 2017.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,500	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	2,500	2,500
Annual IC Time Burden (Hours)	250	250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
IVD Generic Request	VA Generic Fast-Track Clearance Request IVD Survey 2017.docx	12/18/2017

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