Information Collection

Provider Survey

IC 216768 under ICR 202406-2900-010 · OMB 2900-0843.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0843 can be found here:

Documents and Forms

Document Name Document Type
Form 10-10162 Provider Survey Form and Instruction
10-10162 CHALENG Survey - Provider VHA Homeless Programs_Project CHALENG_Provider Survey_2025_revised.docx Form and Instruction
10-10162 CHALENG Survey - Provider 2900-0843 Survey (Provider) 2024-11-18.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Provider Survey	Agency IC Tracking Number:	2900-0843

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 and Instruction	10-10162	CHALENG Survey - Provider	2900-0843 Survey (Provider) 2024-11-18.docx		Yes	No	Fillable Printable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,200	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	Previously Approved
Annual Number of Responses for this IC	3,200	1,400	1,800
Annual IC Time Burden (Hours)	320	140	180
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.