Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
1. VISN 1 Outpatient Mental Health Patient Satisfaction Survey / 2. VE NCA Survey_Non-Sub Change New 13200 2200 0 Other-Satisfaction Survey
Other-Phone Survey
1_Spinal Cord Injury Survey__2_Non-Sub Change-Veterans Experience Access (VE Outpatient Survey) Scheduling Appointment New 80 13 0 Form and Instruction 10-0515 Spinal Cord Injury Patient Care Survey
Other-E-Survey
Board of Veterans' Appeals VEO Surveys (NOD Filing/Hearing/Decision) New 9600 640 0 Other-Survey
Other-Survey
Other-Survey
CEDCC - Community Engagement Digital Comment Card New 9000 600 0 Instruction
CSignals Caregiver Comment Card New 300 10 0 Form CSignals002 CSignals Caregiver Comment Card
Community Nursing Home (CNH) Dementia ECHO: Staff Education Evaluation New 150 25 0 Other-Questionnaire
Other-Questionnaire
Community Nursing Home Program Interviews New 140 140 0 Other-Interview
Community Pulse Check (CPC) Digital Comment Card New 9000 750 0 Form 001 CPC_SurveyWireframe2_v2_withNewQuestion_061719
Form 001 CPC_SurveyWireframe2_v2_07162019.pdf
Community Residential Care (CRC) Program Veteran Survey New 3200 267 0 Other-Survey
Cooperative Studies Program New 305 42 0 Other-Evaluation
Other-Study Site Survey
Other-Satisfaction Survey
Other-Survey
Digital Svc at VA Usability Research Participant Recruiting Screener New 4000 333 0 Other-Questionnaire
HEC Enrollment Survey New 10000 1000 0 Other-Questionnaire
Health Advocate Pilot Project Patient Satisfaction Assessment New 150 13 0 Other-Assessment
Health Resource Center (HRC) Satisfaction Survey New 35000 1750 0 Other-Telephone Survey
Home Health Care Services Satisfaction Questionnaire New 120 10 0 Other-Questionnaire
Home Monitoring for Early Detection of Chronic Disease Exacerbation (COPD) New 25 46 0 Other-Interview Guide
Other-Survey
Other-Questionnaire
Other-Questionnaire
Other-Interview Guide
Other-Questionnaire
Other-Questionnaire
Other-Survey
Hydration Satisfaction of Hines VA CLC Residents New 60 4 0 Other-Survey
Income Verification Process Survey New 2500 250 0 Other-Survey
Income Verification Survey New 2500 250 0 Other-Survey
Medical Foster Home (MFH) Program Caregiver Survey New 700 58 0 Other-Survey
Medical Foster Home (MFH) Program Veteran Survey New 1000 83 0 Other-Survey
Michael DeBakey Satisfation Survey New 100 18 0 Form and Instruction 10-0476 Michael E. Debakey Home Care Program
Mobile App Field Testing (VHA OCC) New 950 950 0 Other-Survey
My HealtheVet Summative Usability Test / VE Non-Sub Change Request_WH HotlineCallSurvey Gender New 18 18 0 Other-Study Plan
Other-Survey/Script
MyVA Access Veteran Interviews New 50 38 0 Other-Interview
NCA Memorial Affairs Survey/ NCA Scheduling Service Survey New 486000 24300 0 Instruction
Nat'l Center on Homelessness Among Veterans - Customer Feedback Survey New 800 67 0 Other-Survey
Network Consolidated Laboratory (NCL) Phlebotomy Service: Patient Satisfaction Questionnaire New 8612 431 0 Form 10-0516 Patient Satisfaction Questionnaire: Network Consolidated Laboratory (NCL) Phlebotomy Service
Office of Accountability and Whistleblower Protection Survey New 200 7 0 Form OAWP 001 Office of Accountability and Whistleblower Protection Survey
Overton Brooks VAMC - ENT Department Survey New 150 13 0 Other-Survey
Pain Management ECHO Evaluation: Patient Perspective New 30 23 0 Other-Telephone Evaluation
Patient Centered Hand Hygiene Survey New 1440 48 0 Form and Instruction 10-xxxx Patient Centered Hand Hygiene Survey Form
Form and Instruction 10-xxxx Semmelweis Hand Hygiene Survey Form - 6 per sheet
Project ATLAS (Advancing Telehealth through Local Access Stations) Telehealth Care Provider Survey New 600 30 0 Other-Survey
Purchased Care Patient Satisfaction Online Survey New 4800 960 0 Form and Instruction 10-0583 Purchased Care Patient Satisfaction Online Survey
Rehabilitation Care Services Satisfaction Survey New 300 25 0 Other-Survey
Remote Veterans Apnea Management Platform (REVAMP) Customer Satisfaction Survey New 1000 167 0 Other-Survey
Revised MISSION Act Comment Card New 12000 400 0 Other-Email Invitation and Reminder
Form 001 MISSION Act Comment Card
Revised VE Outpatient Survey New 200 33 0 Other-E-Survey
SORCC - Veterans Satisfaction Survey of Spiritual Care Needs New 200 7 0 Other-Survey
Spinal Cord Injury Home Care Patient Satisfaction Survey New 30 5 0 Form and Instruction 10-0542 Spinal Cord Injury – Home Care Patient Satisfaction Survey
State Veteran Home Staff Interviews New 40 40 0 Other-Interviews
Survey of Veterans' Satisfaction with the VA Dental Insurance Program (VADIP) New 3180 795 0 Form and Instruction 10-211011 Department of Veterans Affairs Dental Insurance Program Survey
Form and Instruction 10-211011 Final Dental Survey
TeleRehabilitation Enterprise Wide Initiative (TREWI) Patient Satisfaction Survey New 1000 167 0 Other-Telephone Survey
Understanding Patient Perceptions of Access in VISN 22 New 50 25 0 Other-Interview Questions
Update to VEO Outpatient Survey New 1900000 0 0 Instruction
VA Community Care Network Provider Satisfaction Survey for Regions 1, 2, 3 and 4 New 8000 1333 0 Other-Survey
Other-Survey
Other-Survey
Other-Survey
VA Community Care Provider Satisfaction Survey New 2000 333 0 Other-Satisfaction Survey
VA Homeless Program - Customer Feedback Survey New 18000 3000 0 Other-Survey
VA Loma Linda Healthcare System CBOC Clinics - Patient Satisfaction Survey New 1200 100 0 Other-Survey
Other-Survey
VA Pittsburgh Community Nursing Home Satisfaction Survey New 120 10 0 Other-Satisfaction Survey
VCS Customer Satisfaction Focus Groups New 280 93 0 Other-Focus Group Questionnaire
VE: White House Hotline VA Veterans Call Center Online/Phone Survey New 16720 279 0 Other-Survey and Script
Other-Survey
VEO Disability Compensation Survey / VE Outpatient Survey Questions Non-Sub Change Request New 32300 538 0 Other-Web-based Survey
Other-E-Survey
VHA Childcare Services Satisfaction Survey New 1000 17 0 Form and Instruction 10-0531 Childcare Services Satisfaction Survey
VHA Office of Connected Care (OCC) Mobile App Production Store Survey New 500 42 0 Other-Survey
VHA Veteran Inpatient Services VEO Survey / VBA Contact Center New 236112 7870 0 Other-eSurvey
Other-eSurvey
VHA Women Veterans Call Center Survey New 130000 8667 0 Other-Telephone Survey
VISN 1 - Medical Center Solutions Call Centers Customer Satisfaction Survey New 4300 287 0 Other-Telephone Script
VISN 1 CLC Patient Satisfaction Survey New 6450 1075 0 Other-Questionnaire
VISN 1 Call Centers Customer Satisfaction Survey New 4300 287 0 Other-Telephone Survey
VISN 1 NCL Phlebotomy Service - Patient Satisfaction Survey New 8582 429 0 Other-Survey
VISN 12 Telephone Care Services Satisfaction Survey New 200 33 0 Form and Instruction 10-10058 Telephone Care Services Patient Satisfaction Survey
VISN 20 Specialty Access Initiative-Video Follow-Up Visits for Obstructive Sleep Apnea Therapy New 50 38 0 Other-Interview Guide
VetExperOffice_Telehealth Services Survey New 60000 2000 0 Other-Customer Satisfaction Survey
Veteran C&P [Compensation and Pension] Survey New 60944 1016 0 Form and Instruction VEO CP01 C&P Exam Survey Mockup
Form and Instruction C&P02 C&P Exam E-Mail Mockup
Form and Instruction C&P02 CP Exam Survey Mock Up
Veterans Benefits Administration Veterans Success on Campus (VSOC) Survey New 20000 3333 0 Other-Survey
Veterans Choice Program Provider Satisfaction Survey New 2000 333 0 Other-Satisfaction Survey
Veterans Experience Agency Priority Goal (APG) Trust Phone Survey New 1500 250 0 Other-Phone Survey
Veterans Experience Feedback Tool: E-Comment Card New 135 11 0 Other-Web: E-Comment Card
Veterans Experience Office (VEO)_Board of Veterans Appeals Survey New 5400 180 0 Other-Web Survey
Veterans Experience: Education Services VEO Survey New 79200 2640 0 Other-Survey
Veterans Experience: NCA Automated Phone Survey New 3600 180 0 Other-Phone Survey
Vets.gov Fast-track E-Survey Request New 522000 1450 0 Other-E-Survey
Virtual Integrated Multisite Patient Alighted Care Team (V-IMPACT) Comprehensive Evaluation and Review New 50 38 0 Other-Interview
Virtual Nursing Visits to Evaluate Blood Pressure - Provider & Clinician Opinion New 70 18 0 Other-User Inquiry
Other-User Inquiry
White House Hotline Call Center Email/Survey New 4000 67 0 Other-Web Survey
Whole Health Patient Satisfaction Survey New 2400 200 0 Other-survey
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 3754193 73198 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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