Information Collection

VA Voluntary Customer Surveys to Implement E.O. 12862

IC 28764 under ICR 200701-2900-007 · OMB 2900-0569.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0569 can be found here:

Documents and Forms

Document Name Document Type
2900-0569 Survey.pdf www.vba.va.gov/surveys Other-Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	VA Voluntary Customer Surveys to Implement E.O. 12862	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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			2900-0569 Survey.pdf	www.vba.va.gov/surveys	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 95,260	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 10 %

	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	95,260	-36,327	0	131,587
Annual IC Time Burden (Hours)	19,505	0	-3,407	22,912
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

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.