30715 2021 Proposed-Revision_VHA_Medical_Centers_Questionnaire Nov_3_2021

E-Government Website Customer Satisfaction Surveys

OMB: 1090-0008

IC ID: 250368

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
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30715 2021 Proposed-Revision_VHA_Medical_Centers_Questionnaire Nov_3_2021 30715 2021
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 30715 30715 2021 Proposed-Revision_VHA_Medical_Centers_Questionnaire Nov_3_2021 30715 2021 Proposed-Revision_VHA_Medical_Centers_Questionnaire Nov_3_2021.xlsx Yes Yes Fillable Fileable

General Government Central Records & Statistical Mgt

 

2,670 0
   
Individuals or Households
 
   100 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,670 0 0 0 0 2,670
Annual IC Time Burden (Hours) 178 0 0 0 0 178
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Mapping Doc_VHA Medical Centers_Nov 4 2021 (002) Mapping Doc_VHA Medical Centers_Nov 4 2021 (002).docx 11/16/2021
Signed 1090-0008 Generic Clearance Request Form_VHA Medical Centers_Nov 5 2021 Signed 1090-0008 Generic Clearance Request Form_VHA Medical Centers_Nov 5 2021.pdf 11/16/2021
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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