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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.