VHA Community Living Center - Add SCI/D question

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

Documents and Forms

Document Name Document Type
CLC Updated SCI-D Question.docx Other-Survey Instrument
CLC Updated SCI-D Question.docx Other-Survey Instrument
ICR Template_A11 Section 280 Clearance CLC add SCI-D question.docx ICR A-11 Section 280 Clearance request VHA CLC Add SCI/D question IC Document
ICR Template_A11 Section 280 Clearance CLC add SCI-D question.docx ICR A-11 Section 280 Clearance request VHA CLC Add SCI/D question IC Document

Information Collection (IC) Details

IC Title:	VHA Community Living Center - Add SCI/D question	Agency IC Tracking Number:

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
Other-Survey Instrument			CLC Updated SCI-D Question.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

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

Number of Respondents: 10,000	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	10,000	10,000
Annual IC Time Burden (Hours)	333	333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
ICR A-11 Section 280 Clearance request VHA CLC Add SCI/D question	ICR Template_A11 Section 280 Clearance CLC add SCI-D question.docx	11/25/2024

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