VSDHF Engagement Survey

Clearance for A-11 Section 280 Improving Customer Experience Information Collection

OMB: 2900-0876

IC ID: 261791

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

VSDHF Engagement Survey VSDHF Engagement Survey 2900-0876
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction VSDHF Engagement Survey Wireframe VSDHF Engagement Survey Wireframe VSDHF Engagement Survey Wireframe.docx Yes Yes Fillable Fileable

Health Health Care Services

 

500 0
   
Individuals or Households
 
   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 500 0 0 0 0 500
Annual IC Time Burden (Hours) 42 0 0 0 0 42
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
ICR Template_A11 Section 280 Clearance 8 16 23 - VSDHF Enagement Survey ICR Template_A11 Section 280 Clearance 8 16 23 - VSDHF Enagement Survey.docx 08/24/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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