Information Collection

uSPEQ® Consumer Experience Survey (Rehabilitation)

IC 187874 under ICR 202103-2900-007 · OMB 2900-0752.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-0467 uSPEQ® Consumer Experience Survey (Rehabilitation)	Form
VA Form 10-0467 uSPEQ Consumer Experience Survey (Rehabilitation) uSPEQ Survey (09).pdf To Be Determined	Form
VA Form 10-0467 uSPEQ Consumer Experience Survey (Rehabilitation) uSPEQ Survey (09).pdf To Be Determined	Form

IC Title:

uSPEQÂ® Consumer Experience Survey (Rehabilitation)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	VA Form 10-0467	uSPEQ Consumer Experience Survey (Rehabilitation)	uSPEQ Survey (09).pdf	To Be Determined	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 384,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	384,000	384,000
Annual IC Time Burden (Hours)	32,000	32,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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