Information Collection

Virtual Integrated Multisite Patient Alighted Care Team (V-IMPACT) Comprehensive Evaluation and Review

IC 231680 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⚠️ Notice: This information collection may be referencing outdated material.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
V_IMPACT Veteran Interview Guide_Revised 2018_1005.docx Other-Interview
OMB Generic Clearance Submission V-IMPACT.doc Generic Request - V-IMPACT IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Virtual Integrated Multisite Patient Alighted Care Team (V-IMPACT) Comprehensive Evaluation and Review	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-Interview			V_IMPACT Veteran Interview Guide_Revised 2018_1005.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	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	50	50
Annual IC Time Burden (Hours)	38	38
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Request - V-IMPACT	OMB Generic Clearance Submission V-IMPACT.doc	06/07/2018

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