Title:PACT VISN20 Health Care Experiences of Patients with Congestive Heart Failure, Patient Needs Assessment for Clinical Innovations, VA Form 10-0535.
OMB Control Number:2900—New.
Type of Review:New data collection.
Abstract:The data collected on VA Form 10-0535 will be used to identify strengths and weaknesses in the current care delivery system for patients with congestive heart failure.
Affected Public:Individuals or households.
Estimated Annual Burden:100 burden hours.
Estimated Average Burden per Respondent:75 minutes.
Frequency of Response:Annually.
Estimated Number of Respondents:80.
Dated: August 16, 2012.
By direction of the Secretary.
Program Analyst Director, Enterprise Records Service.