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Federal forms, ICRs, and supporting documents

Information Collection

MSCoE Patient Survey/Project ARCH Non-Participant Survey/Wait Rm Television Edu Survey

IC 207373 under ICR 201403-2900-007 · OMB 2900-0770.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

MSCoE Patient Survey/Project ARCH Non-Participant Survey/Wait Rm Television Edu Survey
 
Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 10-211003 MSCoE Patient Survey MSCoE Patient Survey 10-211003.pdf To Be Determined Yes Yes Fillable Fileable
Form VA Form 10-211004 PROJECT ARCH (Access Received Closer to Home) Non-Participating Veterans Survey Project ARCH Non-Participant Survey 10-211004.pdf No   Paper Only
Form VA Form 10-211005 Patient Survey: Waiting Room Television Video Patient Education WaitRoom Televison Ed_Survey 10-211005.pdf No   Paper Only

Health Health Care Services

 

7,515 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 7,515 0 0 0 0 7,515
Annual IC Time Burden (Hours) 1,866 0 0 0 0 1,866
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Multiple Sclerosis Center of Excellence (MSCoE) Outpatient Clinic Generic Request_ MSCoE Patient Survey.docx 06/16/2013
Project ARCH Non-Participating Veterans Survey Generic Request ProjectARCH_NonPPA_Survey.docx 06/16/2013
Patient Survey: Waiting Room Television Video Patient Education Generic_Request_Wait Room Televison Survey.docx 06/16/2013
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.