Information Collection

Grantee Satisfaction Survey - THGP

IC 271211 under ICR 202409-2900-010 · OMB unassigned.

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
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

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 Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	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.