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View ICR - OIRA Conclusion

OMB Control No: 2900-0712	ICR Reference No: 201306-2900-010
Status: Historical Active	Previous ICR Reference No: 201001-2900-008
Agency/Subagency: VA	Agency Tracking No: 2900-0712
Title: Nation-wide Customer Satisfaction Surveys (Survey of Healthcare Experiences of Patients (SHEP))
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/13/2013
	Date Received in OIRA: 07/23/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2016	36 Months From Approved	03/31/2014
Responses	399,000	0	301,244
Time Burden (Hours)	101,750	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 10-1465-5, VA Form 10-1465-3, VA Form 10-1465-2	, ,

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	399,000	301,244	97,756
Annual Time Burden (Hours)	101,750	96,125	5,625
Annual Cost Burden (Dollars)	0	0	0

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 Patient Centered Medical Home 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.

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