OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

MOVE! Weight Management Program for Veterans, Survey of Patient Experiences

ICR 200906-2900-015 · OMB 2900-0753 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form VA Form 10-0472 MOVE! Weight Management Program for Veterans, Survey of Patient Experiences Form and Instruction New Repair queued
MOVE survey response.docx Supplementary Document Uploaded 2010-10-19 Repair queued
Justification B. MOVE_Survey(v2).doc Supporting Statement B Uploaded 2009-09-28 Available
MOVE Survey_Post Card ThankYou and Reminder.pdf Supplementary Document Uploaded 2009-07-09 Available
MOVE Survey Cover Letter.pdf Supplementary Document Uploaded 2009-07-09 Available
MOVE Survey Pre-Notification Letter.pdf Supplementary Document Uploaded 2009-07-09 Available
MOVE_Survey justification A(v3)[1].doc Supporting Statement A Uploaded 2009-10-08 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
189659 MOVE! Weight Management Program for Veterans, Survey of Patient Experiences Form and Instruction New
ICR Details
2900-0753 200906-2900-015
Historical Active
VA
MOVE! Weight Management Program for Veterans, Survey of Patient Experiences
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 11/02/2010
Retrieve Notice of Action (NOA) 10/08/2009
Approved consistent with revisions and supplemental materials submitted by the Department of Veterans Affairs.
  Inventory as of this Action Requested Previously Approved
11/30/2013 36 Months From Approved
5,000 0 0
1,250 0 0
0 0 0
The purpose of this collection is to allow measurement and evaluation of the Department of Veterans Affairs (VA) program. This VA research study is in regard to patient experience with the MOVE! Weight Management Program for Veterans. This information will be used to better understand program effectiveness and design future program enhancements.
US Code: 38 USC Part 1, Chapter 5, Section 527 Name of Law: Veterans Benefits
  
None
Not associated with rulemaking
  74 FR 135 07/16/2009
74 FR 183 09/23/2009
No
  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 5,000 0 0 5,000 0 0
Annual Time Burden (Hours) 1,250 0 0 1,250 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new collection and all burden hours are considered a program increase.
$77,000
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
No
Uncollected
Denise McLamb 202-565-8374 [email protected]
  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.
10/08/2009