Information Collection

2020 002 Q_VAMyHealtheVet_Web_Browse_2020_1_17

IC 239440 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⚠️ Notice: This information collection may be referencing outdated material.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 002 2020 002 Q_VAMyHealtheVet_Web_Browse_2020_1_17	Form and Instruction
002 2020 002 Q_VAMyHealtheVet_Web_Browse_2020_1_17 2020 002 Q_VAMyHealtheVet_Web_Browse_2020_1_17.xlsx	Form and Instruction
1090-0008 Generic Clearance Request Form MyHealtheVet SIGNED.pdf 1090-0008 Generic Clearance Request Form MyHealtheVet SIGNED	IC Document
1090-0008 Survey Mapping Document (VHA) IA 30820.xlsx 1090-0008 Survey Mapping Document (VHA) IA 30820	IC Document

IC Title:

2020 002 Q_VAMyHealtheVet_Web_Browse_2020_1_17

Agency IC Tracking Number:

002

IC Status: New

Obligation to Respond: Mandatory

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	002	2020 002 Q_VAMyHealtheVet_Web_Browse_2020_1_17	2020 002 Q_VAMyHealtheVet_Web_Browse_2020_1_17.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 MyHealtheVet SIGNED	1090-0008 Generic Clearance Request Form MyHealtheVet SIGNED.pdf	01/24/2020
1090-0008 Survey Mapping Document (VHA) IA 30820	1090-0008 Survey Mapping Document (VHA) IA 30820.xlsx	01/24/2020

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