Indiana Survey

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

OMB: 2900-0876

IC ID: 264539

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)

Indiana Survey 2900-0876 Indiana Survey
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Indiana WF 1.12.24 Indiana WF 1.12.24 Indiana WF 1.12.24.docx Yes Yes Fillable Fileable

Health Health Care Services

Veterans, Dependents of Veterans, and Veteran Beneficiaries Survey Records  86 FR 6992

2,500 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 2,500 0 0 0 0 2,500
Annual IC Time Burden (Hours) 83 0 0 0 0 83
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
ICR Template_A11 Section 280 Clearance Indiana Survey 1.19.24 ICR Template_A11 Section 280 Clearance Indiana Survey 1.19.24.docx 01/19/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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