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Federal forms, ICRs, and supporting documents

Information Collection

Veteran Toxic Exposure Screening Tool (PACT Act)

IC 255733 under ICR 202211-2900-011 · OMB 2900-0913.

Documents and Forms
Document Name
Document Type
Other-Screening Survey
Other-Screening Survey
Other-Screening Tool
Information Collection (IC) Details

View Information Collection (IC)

Veteran Toxic Exposure Screening Tool (PACT Act) 2900-NEW
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Screening Survey TOXIC EXPOSURE SCREENING TOOL_0118_updated Jan 2023.docx Yes Yes Fillable Fileable
Other-Screening Tool 2900-0913 Instrument Passback 2023-02-24_VA edits 030723_CLEAN copy 03102023.docx Yes Yes Fillable Fileable

Health Health Care Services

Patient Medical Record -- VA   78 FR 17778

1,660,000 0
   
Individuals or Households
 
   100 %

  Approved 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 1,660,000 0 0 0 0 1,660,000
Annual IC Time Burden (Hours) 138,333 0 0 0 0 138,333
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.