Information Collection

Provider Satisfaction with Mental Health-Clinical Pharmacy Specialists at the Madison VA

IC 229685 under ICR 201801-2900-001 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Provider_MH CPS Survey.docx	Other-Questionnaire

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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-Questionnaire			Provider_MH CPS Survey.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Veteran, Patient, Employee and Volunteer Research and Development Project Records-VA (34VA11)

FR Citation: 59 FR 16705

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	2	2
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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