View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 2900-0712	ICR Reference No: 201112-2900-017
Status: Historical Inactive	Previous ICR Reference No: 201001-2900-008
Agency/Subagency: VA	Agency Tracking No: 2900-0712
Title: Nation-wide Customer Satisfaction Surveys
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 06/04/2013
	Date Received in OIRA: 11/06/2012
Terms of Clearance: Withdrawn to upload revised versions of the instruments and supporting statements.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2014	36 Months From Approved	03/31/2014
Responses	301,244	0	301,244
Time Burden (Hours)	96,125	0	96,125
Cost Burden (Dollars)	0	0	0

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Nation-wide Customer Satisfaction Surveys	VA Form 10-1465-4, VA Form 10-1465-3, VA Form 10-1465-2, VA Form 10-1465-5, VA Form 10-1465-6	, , , ,

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The program change is due to the inclusion of VA Forms 10-1465-5 and 10-1465-6, respectively the C&G PCMH short and long forms. The increase in burden hours is 23,333. However, VHA reduced the amount of SHEP Outpatient Short form surveys (10-1465-4) mailed, such that there will be a net decrease of 25,340 burden hours. VHA is undertaking a new initiative to implement a patient-centered medical home model of care at all VHA Primary Care sites, and is referred to as Patient Aligned Care Teams (PACT). This initiative supports VHA's Universal Health Care Services Plan to redesign VHA healthcare delivery through increasing access, coordination, communication, and continuity of care. PACT provides accessible, coordinated, comprehensive, patient-centered care, and is managed by primary care providers with the active involvement of other clinical and non-clinical staff. PACT allows patients to have a more active role in their health care and is associated with increased quality improvement, patient satisfaction, and a decrease in hospital costs due to fewer hospital visits and readmissions. Currently VHA has no mechanism in place to measure the effectiveness of the PACT model from the patients' perspective. The inclusion of these 2 new forms will fill that void.

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