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VA Cooperative Study Project #500A, National Registry of Veterans with Amyotrophic Lateral Sclerosis (ALS)

IC 28925 under ICR 200907-2900-008 · OMB 2900-0649.

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VA Cooperative Study Project #500A, National Registry of Veterans with Amyotrophic Lateral Sclerosis (ALS) 2900-0649
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 10-21047a Biannual Telephone Interview, National Registry of Veterans with ALS 10-21047a Biannual Telephone Interview.doc No   Paper Only
Form VA Form 10-21074b Verbal Informed Consent VIA Telephone, Nataional Registry of Veterans with ALS 10-21047b Verbal Consent via Telephone.doc No   Paper Only
Form VA Form 10-21047 ALS Registry Screening Form 10-21047 ALS REGISTRY SCREENING FORM.doc No   Paper Only

Health Health Care Services

 

1,808 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 1,808 0 0 -932 0 2,740
Annual IC Time Burden (Hours) 882 0 0 -414 0 1,296
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.