Information Collection

2019 019 VA FeedbackSurvey

IC 235198 under ICR 201805-1090-003 · OMB 1090-0008.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0008 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 019 2019 019 VA FeedbackSurvey	Form and Instruction
019 2019 019 VA FeedbackSurvey 2019 019 VA FeedbackSurvey.xlsx	Form and Instruction
1090-0008 Generic Clearance Request Form VA Feedback FEB 19.pdf 1090-0008 Generic Clearance Request Form VA Feedback FEB 19	IC Document
1090-0008 Survey Mapping Document VA.docx 1090-0008 Survey Mapping Document VA	IC Document

IC Title:

2019 019 VA FeedbackSurvey

Agency IC Tracking Number:

019

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
Form and Instruction	019	2019 019 VA FeedbackSurvey	2019 019 VA FeedbackSurvey.xlsx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,600

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	3,600	3,600
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
1090-0008 Generic Clearance Request Form VA Feedback FEB 19	1090-0008 Generic Clearance Request Form VA Feedback FEB 19.pdf	03/06/2019
1090-0008 Survey Mapping Document VA	1090-0008 Survey Mapping Document VA.docx	03/06/2019

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