View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 2900-0712	ICR Reference No: 201710-2900-010
Status: Historical Active	Previous ICR Reference No: 201605-2900-004
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: Reinstatement with change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/28/2018
	Date Received in OIRA: 01/24/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2021	36 Months From Approved
Responses	794,400	0	0
Time Burden (Hours)	176,640	0	0
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 10-1465-1, VA Form 10-1465-3, VA Form 10-1465-7, VA Form 10-1465-4, VA Form 10-1465-5, VA Form 10-1465-6, VA Form 10-1465-8, VA Form 10-1465-10, VA Form 10-1463-9, VA Form 10-1465-2	, , , , , , , , ,

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses	794,400	283,400	511,000
Annual Time Burden (Hours)	176,640	71,740	104,900
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: VHA has added several forms that may be required by VHA leadership in the near future, and are included here. The program change is due to the inclusion of VA Forms 10-1465-9 and 10-1465-10. In an effort to ask better, more pertinent questions of our patients, VA would like to conduct veteran outreach, focus groups, conduct cognitive testing, and other similar qualitative data collection approaches to better understand emerging patient issues and to ensure the relevancy of the questions asked in the SHEP program.

Annual Cost to Federal Government: $12,500,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

Agency Contact: Cynthia Harvey - Pryor 202 461-5870 cynthia.harvey-pryor@va.gov

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