View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

VCS Patriot Store/Cafe Customer/VCS Focus Group/Patient Experience of Care Survey/VA Dental Service Customer Survey/Mental Health Satisfaction 2900-0770
 
Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 10-0551 VCS Patriot Store and VCS Patriot Cafe Customer Satisfaction Survey VCS Patriot Store_Cafe Survey Form 10-0551.doc No   Paper Only
Other-Training Script VCS Focus Group Training Script.doc No   Paper Only
Form VA form 10-0552 Patient Experience of Care Survey Patient Experiences Survey_10-0552.doc No   Paper Only
Form VA form 10-0553 Dental Service Customer Satisfaction Survey 10-0553_Dental_Satisfaction_Survey_(English_Version)10-20121.docx No   Paper Only
Form VA Form 10-0553S Dental Satisfaction Survey (Spanish version) 10-0553S_Encuesta Satisfaccion de Pacientes Dental (2).docx No   Paper Only
Form VA Form 10-0554 Office of Mental Health Veteran Satisfaction Survey 10-0554_OMH Veteran Survey_July 2012_final.doc TBD Yes Yes Fillable Fileable
Other-Information Script Script forMental Health Satisfaction Survey final[1].doc TBD Yes No Fillable Fileable

Health Health Care Services

 

11,765 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 11,765 0 0 0 0 11,765
Annual IC Time Burden (Hours) 2,632 0 0 0 0 2,632
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Generic_Request VCS Surveys Generic_Request VCS Surveys[1].docx 09/24/2012
Generic Submission-VCS Focus Group Generic Submission-VCS Focus Groups.docx 09/24/2012
Generic_Submission_Request EM Patient Survey Generic_Submission_Request EM Patient Survey[1].docx 09/24/2012
Dental Survey Generic Clearance Submission Dental Survey Generic_Submission_Template (3)[1].docx 09/24/2012
Mental Health Veteran Satisfaction Generic_Request Mental_Health_Generic_Clearance_Submission_final (2).docx 10/05/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.