Information Collection

From War To Home Audience Feedback Questionnaire VA Form 10-10130

IC 212912 under ICR 201409-2900-002 · OMB 2900-0839.

Documents and Forms

Document Name Document Type
Form 10-10130 From War To Home Audience Feedback Questionnaire VA Form 10-10130 Form and Instruction
10-10130 VISN 4 Audience Feedback Questionnaire S1 10-10130 VISN 4 Audience Feedback Questionnaire - 090315.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	From War To Home Audience Feedback Questionnaire VA Form 10-10130	Agency IC Tracking Number:

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
Form and Instruction	10-10130	VISN 4 Audience Feedback Questionnaire	S1 10-10130 VISN 4 Audience Feedback Questionnaire - 090315.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	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
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	83	83
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.