Information Collection

Ethics Consultation Feedback Tool

IC 192020 under ICR 201709-2900-016 · OMB 2900-0750.

Documents and Forms

Document Name Document Type
Form VA Form 10-10065 Ethics Consultation Feedback Tool Form
VA Form 10-10065 Ethics Consultation Feedback Tool VA Form 10-10065.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Ethics Consultation Feedback Tool	Agency IC Tracking Number:	2900-0750

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 10-10065	Ethics Consultation Feedback Tool	VA Form 10-10065.pdf	ECWeb	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 569	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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	569	365	204
Annual IC Time Burden (Hours)	47	30	17
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.