Information Collection

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

IC 189659 under ICR 200906-2900-015 · OMB 2900-0753.

Documents and Forms

Document Name Document Type
Form VA Form 10-0472 MOVE! Weight Management Program for Veterans, Survey of Patient Experiences Form and Instruction
VA Form 10-0472 MOVE! Weight Management Program for Veterans, Survey of MOVE_Patient_Survey(v3).doc Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	MOVE! Weight Management Program for Veterans, Survey of Patient Experiences	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Form and Instruction	VA Form 10-0472	MOVE! Weight Management Program for Veterans, Survey of Patient Experiences	MOVE_Patient_Survey(v3).doc		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	1,250	1,250
Annual IC Cost Burden (Dollars)	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.