Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Emergency Medicine Customer Satisfaction Survey New 208000 10400 0 Form and Instruction 2900-0876-002 Emergency Medicine Customer Satisfaction Survey
Appeals Management Office Survey New 46800 2340 0 Form and Instruction AMO001 AMO Survey Wireframe
Board of Veterans Appeals Surveys New 54360 1812 0 Form and Instruction 2900-0876-Y1 Board Appeal Survey
Form and Instruction 2900-0876-Y2 Board Decision Survey
Form and Instruction 2900-0876-Y3 Board Hearing Survey
Form and Instruction 2900-0876-Y4 Board Notice of Disagreement (NOD) Survey
COVID-19 Vaccine Acceptance New 30000 1000 0 Form and Instruction 2900-0876-Covid vaccine acceptance survey 2900-0876-Covid vaccine acceptance survey
COVID-19 Vaccine Survey New 15000 1250 0 Form and Instruction 2900-0876-AA2-1 COVID-19 Vaccine Trial VA interaction
Form and Instruction 2900-0876-AA2-2 COVID-19 Vaccine Trial Appointment
Form and Instruction 2900-0876-AA2-3 COVID-19 Vaccine Trial Study Team
Form and Instruction 2900-0876-AA2-4 COVID-19 Vaccine Trial VA.Gov
COVID-19 Vaccine Veterans Experience Survey New 250000 8333 0 Form and Instruction 2900-0876-COVID-19 Vaccine Veterans Ex- survey COVID-19 Vaccine Veterans Ex- survey wireframe
Clinical Contact Center Survey New 8688 434 0 Form and Instruction 2020-2900-0876-R1 Clinical Contact Center Survey
Community Care Customer Experience Survey New 54000 2700 0 Form and Instruction 2020-2900-0876-T2 Community Care Survey Wireframes
Covid-19 Veteran Customer Satisfaction Survey New 10800 540 0 Form 2900-0876-07A Covid-19 Telehealth Survey
Form 2900-0876-07B Covid-19 Post-Visit Survey
Form 2900-0876-07C Covid-19 General Survey
Education Services Survey New 42924 2146 0 Form 2900-0876-2020-5 Education Services Survey Wireframe
Emergency Medicine Community Care Survey New 7212 361 0 Form and Instruction Emergency Medicine Community Care survey wireframe Emergency Medicine Community Care survey wireframe
Emergency Medicine Telehealth Customer Satisfaction Survey New 9900 495 0 Form and Instruction 2900-0876-EMT-1 Emergency Medicine Telehealth Survey Wireframe
Enterprise Contact Center Council Community Care (ECCC CC) Survey New 49152 3277 0 Form and Instruction 2900-0875-AA1 ECCC Community Care Survey
Enterprise Contact Center Council Debt Management Center Survey New 650000 21667 0 Form and Instruction 2900-0876-AD1 ECCC DMC Survey
Enterprise Contact Center Council National Cemetery Administration (ECCC NCA) Survey New 5328 178 0 Form and Instruction 2900-0876-AA ECCC_NCA_Survey
Enterprise Contact Center Council Veterans Experience Office (ECCC VEO) New 794535 26485 0 Form and Instruction 2900-0876-Z1 ECCC_VEO Tier 1 Post Call Survey
Form and Instruction 2900-0876-Z2 ECCC_VEO White House Hotline Post Call Survey
Financial Services Center Vendor Support Survey New 2042 102 0 Form and Instruction 2900-0876-AB1 Financial Services Center Vendor Support Survey Wireframe
Geriatrics Extended Care (GEC) Survey New 16796 1400 0 Form and Instruction 2900-0876-GEC-survey wireframes 2900-0876-GEC-survey wireframes
MAPPING THE CROSS-AGENCY CUSTOMER EXPERIENCE JOURNEY New 100 117 0 Form and Instruction 2900-0876-R2 Cross Agency Field Guide
Member Services Contact Center Survey New 182000 9100 0 Form and Instruction 2900-0876-Q3A Member Services Contact Center Survey Wireframe
No Show Imaging Survey New 12492 625 0 Form and Instruction No Show Imaging Survey No Show Imaging Survey
No Show Survey New 6969 348 0 Form and Instruction 2900-0876-003 No Show Survey Questions Established Patients
Form and Instruction 2900-0876-004 No Show Survey Questions New Patients
OPIA/VEO Customer Survey New 5000 167 0 Form and Instruction OPIA/VEO Customer Survey OPIA/VEO Customer Survey
Office of Resolution Management, Diversity & Inclusion (ORMDI) Brand Health Survey New 52087 1736 0 Form and Instruction 2900-0876-AC1 ORMDI Brand Health Survey
Outpatient Services Surveys New 7835048 391752 0 Form and Instruction 2900-0876-V1 Outpatient Healthcare Visit
Form and Instruction 2900-0876-V4 Pharmacy by Mail
Form and Instruction 2900-0876-V5 Pharmacy in Person
Form and Instruction 2900-0876-V3 Labs and Imaging
Form and Instruction 2900-0876-V2 Scheduling an Appointment
Preferences for Care During Covid Survey New 30000 1500 0 Form and Instruction 2900-0876-C2 Preferences for Care During Covid Survey
Readjustment Counseling Services (RCS) Vet Center Survey New 57600 4416 0 Form and Instruction 2900-0876-RCS Survey Wireframes 2900-0876-RCS Survey Wireframes
Same Day Services Survey New 238848 19904 0 Form and Instruction 2900-08767-S1 Same Day Services Survey Questions
Telemedicine New 604800 40320 0 Form and Instruction 2900-0876-AB1 Telemedicine Home Continuing Patient
Form and Instruction 2900-0876-AB2 Telemedicine Appointment Scheduling
Form and Instruction 2900-AB3 Telemedicine At Home or Mobile Appointment
Form and Instruction 2900-0876-AB4 Telemedicine Clinic Appointment
Form and Instruction 2900-0876-AB5 Telemedicine Store Forward At Home or Mobile Appointment
Form and Instruction 2900-0876-AB6 Telemedicine Store Forward Results
Transition Care and Management VA Liaison Survey New 10032 669 0 Form and Instruction 2900-0876-Transition Care and Management VA Liaiso Transition Care and Management VA Liaison Survey
VA.gov A-11 Survey New 40000 2000 0 Form and Instruction 2900-0876-Q2 VA.Gov A-11 Survey Questions
VBA Contact Center Survey New 67464 4498 0 Form and Instruction 2020-2900-0876-S1 VBA Contact Center Survey
VEAC Survey New 4000 200 0 Form and Instruction 2900-0876-VEAC Survey Wireframe 2900-0876-VEAC Survey Wireframe
VHA Inpatient Survey New 546968 18232 0 Form and Instruction 2900-0876 - VHA Inpatient Survey wireframe VHA Inpatient Survey wireframe
Veterans Safety Survey New 57331 1911 0 Form and Instruction 2900-0876-Veterans Safety Survey 2900-0876-Veterans Safety Survey
Total Burden Actually Used for Information Collections Under Currently Approved ICR: 12006276 582415 0  
Total Burden Currently Requested for Information Collections Under Currently Approved ICR: 0 0 0  
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