Information Collection

30820 Q VAMyHealtheVet Mobile_1-5-2022 by Chris Nelson

IC 251350 under ICR 202204-1090-002 · OMB 1090-0008.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0008 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 30820 Q VAMyHealth 30820 Q VAMyHealtheVet Mobile_1-5-2022 by Chris Nelson	Form and Instruction
30820 Q VAMyHealth 30820 Q VAMyHealtheVet Mobile_1-5-2022 by Chris Nelson 30820 Q VAMyHealtheVet Mobile_1-5-2022 by Chris Nelson.xlsx	Form and Instruction
30820 Q VAMyHealth 30820 Q VAMyHealtheVet Mobile_1-5-2022 by Chris Nelson 30820 Q VAMyHealtheVet Mobile_1-5-2022 by Chris Nelson.xlsx	Form and Instruction
1090-0008 Generic Clearance Request Form MyHealtheVet Mobile Jan 07 2022.pdf 1090-0008 Generic Clearance Request Form MyHealtheVet Mobile Jan 07 2022	IC Document
1090-0008 Generic Clearance Request Form MyHealtheVet Mobile Jan 07 2022.pdf 1090-0008 Generic Clearance Request Form MyHealtheVet Mobile Jan 07 2022	IC Document
Survey Mapping Document (VHA) IA 30820 Mobile Jan 07 2022.xlsx Survey Mapping Document (VHA) IA 30820 Mobile Jan 07 2022	IC Document
Survey Mapping Document (VHA) IA 30820 Mobile Jan 07 2022.xlsx Survey Mapping Document (VHA) IA 30820 Mobile Jan 07 2022	IC Document

IC Title:

30820 Q VAMyHealtheVet Mobile_1-5-2022 by Chris Nelson

Agency IC Tracking Number:

30820 Q VAMyHealtheVet Mobile_1-5-2022 by Chris Ne

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 and Instruction	30820 Q VAMyHealtheVet Mobile_1-5-2022 by Chris Ne	30820 Q VAMyHealtheVet Mobile_1-5-2022 by Chris Nelson	30820 Q VAMyHealtheVet Mobile_1-5-2022 by Chris Nelson.xlsx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 24,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	24,000	24,000
Annual IC Time Burden (Hours)	1,200	1,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
1090-0008 Generic Clearance Request Form MyHealtheVet Mobile Jan 07 2022	1090-0008 Generic Clearance Request Form MyHealtheVet Mobile Jan 07 2022.pdf	01/28/2022
Survey Mapping Document (VHA) IA 30820 Mobile Jan 07 2022	Survey Mapping Document (VHA) IA 30820 Mobile Jan 07 2022.xlsx	01/28/2022

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