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Homelessness Survey
Clearance for A-11 Section 280 Improving Customer Experience Information Collection
OMB: 2900-0876
IC ID: 260783
OMB.report
VA
OMB 2900-0876
ICR 202503-2900-010
IC 260783
( )
Documents and Forms
Document Name
Document Type
Form Homelessness WF 6.
Homelessness Survey
Form and Instruction
Form Homelessness WF 6.
Homelessness Survey
Form and Instruction
Homelessness WF 6. Homelessness WF 6.7.23 v3
Homelessness WF 6.7.23 v3.docx
Form and Instruction
Homelessness WF 6. Homelessness WF 6.7.23 v3
Homelessness WF 6.7.23 v3.docx
Form and Instruction
ICR Template_A11 Section 280 Clearance Homelessness v3.docx
ICR Template_A11 Section 280 Clearance Homelessness v3
IC Document
ICR Template_A11 Section 280 Clearance Homelessness v3.docx
ICR Template_A11 Section 280 Clearance Homelessness v3
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Homelessness Survey
Agency IC Tracking Number:
Homelessness Survey 2900-0876
IC Status:
Unchanged
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 and Instruction
Homelessness WF 6.7.23 v3
Homelessness WF 6.7.23 v3
Homelessness WF 6.7.23 v3.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:
Veterans, Dependents of Veterans, and Veteran Beneficiaries Survey Records
FR Citation:
86 FR 6992
Number of Respondents:
24,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
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
24,000
0
0
0
0
24,000
Annual IC Time Burden (Hours)
2,000
0
0
0
0
2,000
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
ICR Template_A11 Section 280 Clearance Homelessness v3
ICR Template_A11 Section 280 Clearance Homelessness v3.docx
06/23/2023
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.