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Federal forms, ICRs, and supporting documents

Information Collection Request

EASTERN BLIND REHABILITATION CENTER (EBRC) PATIENT SATISFACTION QUESTIONNAIRE

ICR 197701-2900-035 · OMB 2900-0248 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
174582 EASTERN BLIND REHABILITATION CENTER (EBRC) PATIENT SATISFACTION QUESTIONNAIRE Form Migrated
ICR Details
2900-0248 197701-2900-035
Historical Active 197511-2900-002
VA
EASTERN BLIND REHABILITATION CENTER (EBRC) PATIENT SATISFACTION QUESTIONNAIRE
No material or nonsubstantive change to a currently approved collection   No
Emergency 01/24/1977
Approved with change 01/24/1977
Retrieve Notice of Action (NOA) 01/24/1977
  Inventory as of this Action Requested Previously Approved
11/30/1980 11/30/1980 11/30/1980
100 0 500
50 0 250
0 0 0
USED TO EVALUATE BOTH THE SERVICES PROVIDED BY THE BLIND REHABILITATION CENTER AND THE EFFECTIVENESS OF BLIND REHABILITATION ON THE VETERAN'S LIFE.
None
None
No
1
IC Title Form No. Form Name
EASTERN BLIND REHABILITATION CENTER (EBRC) PATIENT SATISFACTION QUESTIONNAIRE 10-54(689)
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 100 500 0 0 -400 0
Annual Time Burden (Hours) 50 250 0 0 -200 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/24/1977