Information Collection

Veteran Self-Check Assessment (SCA)

IC 256118 under ICR 202204-2900-015 · OMB unassigned.

Documents and Forms

IC Title:

Agency IC Tracking Number:

VHA-2900-NEW

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Online Assessment	SCQ P1.PNG	Yes	Yes	Fillable Fileable
Other-Online Assessment	SCQ P2.PNG	Yes	Yes	Fillable Fileable
Other-Online Assessment	SCQ P3.PNG	Yes	Yes	Fillable Fileable
Other-Online Assessment	SCQ P4.PNG	Yes	Yes	Fillable Fileable
Other-Online Assessment	SCQ P5.PNG	Yes	Yes	Fillable Fileable
Other-Online Assessment	SCQ P6.PNG	Yes	Yes	Fillable Fileable
Other-Online Assessment	SCQ P7.PNG	Yes	Yes	Fillable Fileable
Other-Online Assessment	SCQ P8.PNG	Yes	Yes	Fillable Fileable
Other-Online Assessment	SCQ P9.PNG	Yes	Yes	Fillable Fileable
Other-Online Assessment	SCQ P10.PNG	Yes	Yes	Fillable Fileable
Other-Online Assessment	SCQ P11.PNG	Yes	Yes	Fillable Fileable
Other-Online Assessment	SCQ P12.PNG	Yes	Yes	Fillable Fileable
Other-Online Assessment	SCQ Welcome Page.PNG	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11,783

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	11,783	11,783
Annual IC Time Burden (Hours)	1,964	1,964
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.