Information Collection

VEAC Exit and Email Surveys

IC 252946 under ICR 202301-2900-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form VEAC Exit Survey a VEAC Exit and Email Surveys	Form and Instruction
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

IC Title:

VEAC Exit and Email Surveys

Agency IC Tracking Number:

2900-VEAC Exit and Email Surveys

Is this a Common Form? Yes

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	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 %

table that charts list of burden
	Approved	Previously Approved
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

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.