Information Collection

My HealtheVet Summative Usability Test / VE Non-Sub Change Request_WH HotlineCallSurvey Gender

IC 231130 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
MHV MVAHJ Joint Study Plan.docx Usability Testing	Other-Study Plan
4.27.18 WHHL SurveyCopyDeck.pdf Email Survey and Phone Survey	Other-Survey/Script
VA Generic Fast-Track Clearance Request MHV 2018 Summative Testing.docx Generic Request_MHV Summative Test	IC Document
WH_Hotline Gender_NonSubChange_05.03.18.docx WH_Hotline Gender_NonSubChange_05.03.18	IC Document
2900-0770 WH_HotlineSurvey_FastTrack_Request.docx 2900-0770 WH_HotlineSurvey_FastTrack_Request	IC Document
NOA 4-19-18 WhiteHouse HotlineCallSurvey.pdf NOA 4-19-18 WhiteHouse HotlineCallSurvey	IC Document

IC Title:

My HealtheVet Summative Usability Test / VE Non-Sub Change Request_WH HotlineCallSurvey Gender

Agency IC Tracking Number:

2900-0770

IC Status: New

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
Other-Study Plan			MHV MVAHJ Joint Study Plan.docx	Usability Testing	No		Paper Only
Other-Survey/Script			4.27.18 WHHL SurveyCopyDeck.pdf	Email Survey and Phone Survey	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 18

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	18	18
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Request_MHV Summative Test	VA Generic Fast-Track Clearance Request MHV 2018 Summative Testing.docx	04/19/2018
WH_Hotline Gender_NonSubChange_05.03.18	WH_Hotline Gender_NonSubChange_05.03.18.docx	05/04/2018
2900-0770 WH_HotlineSurvey_FastTrack_Request	2900-0770 WH_HotlineSurvey_FastTrack_Request.docx	05/04/2018
NOA 4-19-18 WhiteHouse HotlineCallSurvey	NOA 4-19-18 WhiteHouse HotlineCallSurvey.pdf	05/04/2018

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