Information Collection

VA.gov A-11 Survey

IC 242822 under ICR 202003-2900-011 · OMB 2900-0876.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0876 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2900-0876-Q2 VA.gov A-11 Survey	Form and Instruction
2900-0876-Q2 VA.Gov A-11 Survey Questions Medallia VA Comment Card Questions (004).xlsx	Form and Instruction
A-11 Fast-Track Clearance Request VA.gov Trust Metrics (004).docx Survey Requirements Document	IC Document

IC Title:

VA.gov A-11 Survey

Agency IC Tracking Number:

2900-0876-Q1

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	2900-0876-Q2	VA.Gov A-11 Survey Questions	Medallia VA Comment Card Questions (004).xlsx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 40,000

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	40,000	40,000
Annual IC Time Burden (Hours)	2,000	2,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Survey Requirements Document	A-11 Fast-Track Clearance Request VA.gov Trust Metrics (004).docx	07/27/2020

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