Information Collection

Health Professions Trainee Data Collection Form - VA Form 2850d

IC 235698 under ICR 202301-2900-008 · OMB 2900-0205.

Documents and Forms

Document Name Document Type
Form 10-2850d Health Professions Trainee Data Collection Form - VA Form 2850d Form and Instruction
10-2850d Health Professions Trainee Data Collection Form - VA For VHA Form 10-2850d_updates 2022.pdf Form and Instruction
10-2850d Health Professions Trainee Data Collection Form - VA For VA Form 10-2850d.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Health Professions Trainee Data Collection Form - VA Form 2850d	Agency IC Tracking Number:	2900-0205

Is this a Common Form? Yes		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	10-2850d	Health Professions Trainee Data Collection Form - VA Form 10-2850d	VA Form 10-2850d.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 121,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Previously Approved
Annual Number of Responses for this IC	121,000	121,000
Annual IC Time Burden (Hours)	60,500	60,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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