OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Health Insurance and Key Driver Modules - Survey of Veteran Enrollees' Health and Reliance Upon VA

IC 45604 under ICR 200610-2900-003 · OMB 2900-0693.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
Form
Information Collection (IC) Details

View Information Collection (IC)

Health Insurance and Key Driver Modules - Survey of Veteran Enrollees' Health and Reliance Upon VA
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 10-21034k Key Drivers Module 2 2900-New 10-21034k module 2 .xls No   Paper Only
Form VA Form 10-21034j Health Insurance Module 1 2900-New Cover for 10-21034j module 1.pdf No   Paper Only
Form VA Form 10-21034j Cover Sheet for Health Insurance Module 1 2900-New 10-21034j module 1.xls No   Paper Only
Form VA Form 10-21034k Cover Sheet for Key Drivers Module 2 2900-New Cover for 10-21034k module 2 .pdf No   Paper Only


 

44,000 0
   
Individuals or Households
 
   0 %

  Approved 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 44,000 0 44,000 0 0 0
Annual IC Time Burden (Hours) 3,168 0 3,168 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.