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MOVE! Weight Management Program

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Paperwork Reduction Act

The Paperwork Reduction Act of 1995 requires us to notify you that this information collection is in accordance with the clearance requirements of section 3507 of the Paperwork Reduction Act of 1995. As this information is collected to facilitate the healthcare of Veterans, this questionnaire is not required to have an Office of Management and Budget (OMB) number. We anticipate that the time needed to complete the questionnaire will average eleven (11) minutes, including reading the instructions. This collection of information is intended to fulfill the need identified by the Department of Veterans Affairs (VA) to assist you in identifying your personal stumbling blocks for managing your weight and collecting other information critical to assisting you with managing your weight. Results will be used to automatically produce a report which summarizes your weight management profile and points you to materials that can address your individual needs. This information is stored in an anonymous format. Veterans: if you are enrolled in VA healthcare, you can share this information with your healthcare team by printing the report and bringing the report to your next Primary Care appointment. The report contains a retrieval number which will allow you to make the report a part of your VA medical record. Use of this questionnaire is voluntary and failure to participate will have no adverse effect on benefits to which you might otherwise be entitled.


Please also review the Privacy Act Information.

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