Information Collection

Survey of Veteran Enrollees' Health and Reliance Upon VA

IC 28855 under ICR 201212-2900-013 · OMB 2900-0609.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0609 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 10-21034G Survey of Veteran Enrollees' Health and Reliance Upon VA Form
VA Form 10-21034G (CATI) Survey of Veteran Enrollees VA Form 10-20134g_SoE_Proposed CATI 2013.doc URL to be determined (Multi-mode survey) Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Survey of Veteran Enrollees' Health and Reliance Upon VA	Agency IC Tracking Number:	2900-0609

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
Form	VA Form 10-21034G	(CATI) Survey of Veteran Enrollees	VA Form 10-20134g_SoE_Proposed CATI 2013.doc	URL to be determined (Multi-mode survey)	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 42,080	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	42,080	0	42,080
Annual IC Time Burden (Hours)	14,728	328	14,400
Annual IC Cost Burden (Dollars)	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.