Information Collection

Blind and Low Vision Rehabilitation Survey

IC 268074 under ICR 202503-2900-010 · OMB 2900-0876.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0876 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Blind Rehab Wireframe.docx	Other-Survey Instrument
Blind Rehab Wireframe.docx	Other-Survey Instrument
ICR Template_A11 Section 280 Clearance 8 16 23.docx Blind and Low Vision Rehab Survey Cover sheet	IC Document
ICR Template_A11 Section 280 Clearance 8 16 23.docx Blind and Low Vision Rehab Survey Cover sheet	IC Document
Blind Rehabilitation Services sample plan final.docx Blind and Low Vision Rehab Survey Sample Plan	IC Document
Blind Rehabilitation Services sample plan final.docx Blind and Low Vision Rehab Survey Sample Plan	IC Document

IC Title:

Blind and Low Vision Rehabilitation Survey

Agency IC Tracking Number:

2900-0876

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey Instrument					Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Veterans, Dependents of Veterans, and Veteran Beneficiaries

FR Citation: 86 FR 6992

Number of Respondents: 18,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	18,000	18,000
Annual IC Time Burden (Hours)	1,500	1,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Blind and Low Vision Rehab Survey Cover sheet		05/30/2024
Blind and Low Vision Rehab Survey Sample Plan		05/30/2024

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

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