View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 2900-0712	ICR Reference No: 201312-2900-022
Status: Historical Active	Previous ICR Reference No: 201306-2900-010
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 without change	Conclusion Date: 03/14/2014
	Date Received in OIRA: 01/24/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2017	36 Months From Approved	12/31/2016
Responses	511,000	0	399,000
Time Burden (Hours)	104,900	0	101,750
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 10-1465-6, VA Form 10-1465-8, VA Form 10-1465-7, VA Form 10-1465-2, VA Form 10-1465-1, VA Form 10-1465-3, VA Form 10-1465-5, VA Form 10-1465-4	, , , , , , ,

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	511,000	399,000	112,000
Annual Time Burden (Hours)	104,900	101,750	3,150
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 10-1465-1 Inpatient long form, 10-1465-5, 10-1465-6 Patient Centered Medical Home (PCMH) SHEP long form, 10-1465-7 Home Healthcare CAHPS (HH CAHPS), and 10-1465-8 In-Center Hemodialysis CAHPS (ICHemoCAHPS) survey forms. 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.

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