survivor Survey

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

Documents and Forms

Document Name Document Type
Form Survivor Survey survivor Survey Form and Instruction
Form Survivor Survey survivor Survey Form and Instruction
Survivor Survey Survivor Survey Survivor Survey Wireframe_2024.05.14.docx Form and Instruction
Survivor Survey Survivor Survey Survivor Survey Wireframe_2024.05.14.docx Form and Instruction
ICR Template_A11 Section 280 2024.05.14.pdf Survivor Survey IC Document
ICR Template_A11 Section 280 2024.05.14.pdf Survivor Survey IC Document

Information Collection (IC) Details

IC Title:	survivor Survey	Agency IC Tracking Number:	2900-0876_Survivor Survey

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	Survivor Survey	Survivor Survey	Survivor Survey Wireframe_2024.05.14.docx		Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title: Veterans, Dependents of Veterans, and Veteran Beneficiaries	FR Citation: 86 FR 6992

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Survivor Survey	ICR Template_A11 Section 280 2024.05.14.pdf	05/14/2024

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.