Outpatient-Labs and Imaging - Add Mammography Questions

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

OMB: 2900-0876

IC ID: 261804

Documents and Forms
Document Name
Document Type
Other-Survey Instrument
Other-Survey Instrument
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Outpatient-Labs and Imaging - Add Mammography Questions 2900-0876 Mammography
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Survey Instrument Outpatient-Labs Imaging -Mammography - Survey WF .docx Yes Yes Fillable Fileable

Health Health Care Services

Veterans, Dependents of Veterans and Veteran Beneficiaries  86 FR 6992

2,000 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 2,000 0 0 0 0 2,000
Annual IC Time Burden (Hours) 67 0 0 0 0 67
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Outpatient Sample Plan Service Level Measurement - Outpatient Sampling Plan June 2018_v4.docx 08/24/2023
Outpatient Labs & Imaging - Add Mammography Questions ICR Template_A11 Section 280 Clearance Mammography.docx 08/25/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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