Information Collection

VA Voluntary Customer Surveys to Implement E.O. 12862

IC 28764 under ICR 200703-2900-012 · OMB 2900-0569.

Documents and Forms

Document Name Document Type
2900-0569 83C Surveys.pdf www.va.gov/vba/survey Other-survey

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	VA Voluntary Customer Surveys to Implement E.O. 12862	Agency IC Tracking Number:

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
Other-survey			2900-0569 83C Surveys.pdf	www.va.gov/vba/survey	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 95,260	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 10 %

	Approved	Previously Approved
Annual Number of Responses for this IC	95,260	95,260
Annual IC Time Burden (Hours)	19,505	19,505
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.