Information Collection

VEAC Exit and Email Surveys

IC 252946 under ICR 202204-2900-003 · OMB 2900-0912.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0912 can be found here:

Documents and Forms

Document Name Document Type
Form VEAC Exit Survey a VEAC Exit and Email Surveys Form and Instruction
VEAC Exit Survey a VEAC Exit Survey and VEAC Email Survey Wireframes VEAC Exit Survey and VEAC Email Survey Wireframes.pdf Form and Instruction
VEAC Exit Survey a VEAC Exit Survey and VEAC Email Survey Wireframes VEAC Exit Survey and VEAC Email Survey Wireframes.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	VEAC Exit and Email Surveys	Agency IC Tracking Number:	2900-VEAC Exit and Email Surveys

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	VEAC Exit Survey and VEAC Email Survey Wireframes	VEAC Exit Survey and VEAC Email Survey Wireframes	VEAC Exit Survey and VEAC Email Survey Wireframes.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	12,000	12,000
Annual IC Time Burden (Hours)	1,000	1,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.