Information Collection

VA Homeless Program - Customer Feedback Survey

IC 238195 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⚠️ Notice: This information collection may be referencing outdated material.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
HPO_Customer Feedback Survey_Generic PRA Clearance_OMB passback_FINAL_04232020.docx	Other-Survey
Generic Supp Statement_VA Homeless Prog - Cust Feedback Survey_revised_2020.docx Generic Supp Stmnt - VA Homeless Program - Customer Feedback Survey	IC Document

IC Title:

VA Homeless Program - Customer Feedback Survey

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-Survey			HPO_Customer Feedback Survey_Generic PRA Clearance_OMB passback_FINAL_04232020.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 18,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	18,000	18,000
Annual IC Time Burden (Hours)	3,000	3,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Supp Stmnt - VA Homeless Program - Customer Feedback Survey	Generic Supp Statement_VA Homeless Prog - Cust Feedback Survey_revised_2020.docx	02/28/2020

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