Information Collection

Veteran Toxic Exposure Screening Tool (PACT Act)

IC 255733 under ICR 202209-2900-002 · OMB 2900-0913.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0913 can be found here:

Documents and Forms

Document Name Document Type
TOXIC EXPOSURE SCREEN_PACT ACT_09012022.docx Other-Screening Survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Veteran Toxic Exposure Screening Tool (PACT Act)	Agency IC Tracking Number:	2900-NEW

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
Other-Screening Survey			TOXIC EXPOSURE SCREEN_PACT ACT_09012022.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Patient Medical Record -- VA	FR Citation: 78 FR 17778

Number of Respondents: 1,660,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,660,000	1,660,000
Annual IC Time Burden (Hours)	138,333	138,333
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.