View Information Collection (IC)

View Information Collection (IC)

Nation-wide Customer Satisfaction Surveys 2900-0712
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction VA Form 10-1465-3 SHEP Outpatient Long Form 10-1465-3 VA Form 10-1465-3 update[1].pdf No   Paper Only
Form and Instruction VA Form 10-1465-4 SHEP Outpatient Short Form 10-1465-4 VA Form 10-1465-4 update[1].pdf No   Paper Only
Form and Instruction VA Form 10-1465-2 HCAHPS SHEP Core Short Form 10-1465-2 VA Form 10-1465-2[1].pdf No   Paper Only
Form and Instruction VA Form 10-1465-5 Clinician and Group Survey , Patient Centered Medical Home VA Form 10-1465-5, Clinician_Group Survey Pat Cntrd Med Home_short form.pdf No   Paper Only
Form and Instruction VA Form 10-1465-6 Clinician and Group Survey Patient Centered Medical Home VA Form 10-1465-6, Clinician and Group Survey Pat Centered Med Home_Long form(1).pdf No   Paper Only

Health Health Care Services

 

313,224 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 313,224 0 88,000 -76,020 0 301,244
Annual IC Time Burden (Hours) 94,118 0 23,333 -25,340 0 96,125
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.