Information Collection

COVER Commission Focus Group Veterans Demographics Survey

IC 235915 under ICR 201905-2900-001 · OMB 2900-0868.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
COVER Comm_Veterans Demographics Survey_OMB passback revision_06172019_FINAL.docx	Other-Survey
CARA Legislation_PL 114 198 Sect 931_COVER Commission.docx CARA Legislation_PL 114-198_Section 931_COVER Commission	IC Document

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-Survey			COVER Comm_Veterans Demographics Survey_OMB passback revision_06172019_FINAL.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
CARA Legislation_PL 114-198_Section 931_COVER Commission	CARA Legislation_PL 114 198 Sect 931_COVER Commission.docx	05/01/2019

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