Information Collection

CRC Inident Reporting

IC 271045 under ICR 202409-2900-003 · OMB 2900-0491.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

CRC Inident Reporting

Agency IC Tracking Number:

2900-0491

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 38 CFR 17.63(j)

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 950

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	950	950
Annual IC Time Burden (Hours)	2,850	2,850
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.