Information Collection

James A Haley Veterans Hospital (JAHVH) - Quality Improvement & Clinical Research Studies Registry Survey

IC 255374 under ICR 202007-2900-004 · OMB 2900-0770.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0770 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
JAHVH Quality Improvement and Clinical Research Studies Registry Survey_updated Aug 2022.docx	Other-Registry Survey
Generic Supporting Statement_JAHVH Quality Improvement and Clinical Research Studies Registry Survey_updated Aug 2022.docx Generic Supporting Statement - James A. Haley Veterans Hospital (JAHVH) - Quality Improvement & Clinical Research Studies Regist	IC Document

IC Title:

James A Haley Veterans Hospital (JAHVH) - Quality Improvement & Clinical Research Studies Registry Survey

Agency IC Tracking Number:

VHA-2900-0770

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-Registry Survey					Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

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	5,000	5,000
Annual IC Time Burden (Hours)	833	833
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Supporting Statement - James A. Haley Veterans Hospital (JAHVH) - Quality Improvement & Clinical Research Studies Registry Survey - Aug 2022		08/18/2022

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

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