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Grantee Satisfaction Survey - THGP
Telehealth Grant Program (THGP) - AS20
OMB:
IC ID: 271211
OMB.report
VA
ICR 202409-2900-010
IC 271211
( )
Documents and Forms
Document Name
Document Type
Form 10-396a
Grantee Satisfaction Survey - THGP
Form
10-396a Grantee Satisfaction Survey Form
Grantee Satisfaction Survey_Telehealth Grant Program_draft.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Grantee Satisfaction Survey - THGP
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:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
10-396a
Grantee Satisfaction Survey Form
Grantee Satisfaction Survey_Telehealth Grant Program_draft.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
50
Number of Respondents for Small Entity:
0
Affected Public:
Private Sector
Private Sector:
Businesses or other for-profits, Not-for-profit institutions
Percentage of Respondents Reporting Electronically:
50 %
Requested
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
50
0
50
0
0
0
Annual IC Time Burden (Hours)
17
0
17
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.
