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 10-1465-1 SHEP InPatient Long Form 10-1465-1 SHEP_IP_Long Form 10-1465-1a.pdf No   Paper Only
Form and Instruction VA Form 10-1465-2 SHEP InPatient Short Form 10-1465-2 SHEP_IP_Survey_FY15T04_Short_Extended_Eng_12.22.2015_rev03a.pdf No   Paper Only
Form and Instruction VA Form 10-1465-3 SHEP OutPatient Long Form 10-1465-3 SHEP_OutPatient_Long Form 10-1465-3a.pdf No   Paper Only
Form and Instruction VA Form 10-1465-4 SHEP OutPatient Short Form 10-1465-4 SHEP_OutPatient_Short Form 10-1465-4a.pdf No   Paper Only
Form and Instruction VA Form 10-1465-5 SHEP Patient Centered Medical Homes (PCMH) Short Form 10-1465-5 SHEP_PCMH_Survey_FY16T04_Short_Eng_12.22.2015_rev03a.pdf No   Paper Only
Form and Instruction VA Form 10-1465-6 SHEP Patient Centered Medical Homes (PCMH) Long Form 10-1465-6 SHEP_PCMH_Survey_FY16T04_Long_Flu_Eng_12.22.2015_rev03a.pdf No   Paper Only
Form and Instruction VA Form 10-1465-7 SHEP Home Healthcare CAHPS Long Form 10-1465-7 SHEP_HHCAHPS Long Form 10-1465-7a.pdf No   Paper Only
Form and Instruction VA Form 10-1465-8 SHEP In-Center Hemodialysis (ICHemo) Long Form 10-1465-8 SHEP_ICHemo Long Form 10-1465-8a.pdf No   Paper Only
Form and Instruction VA Form 10-1465-9 SHEP Specialty Care Survey Form 10-1465-9 SHEP_SC_Survey_FY16T04_CG_Non-Visit_Eng_12.22.2015_rev03a.pdf No   Paper Only

Health Public Health Monitoring

 

511,000 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 511,000 0 0 0 0 511,000
Annual IC Time Burden (Hours) 104,900 0 0 0 0 104,900
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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