View Information Collection Request (ICR) Package

Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.

View ICR - OIRA Conclusion

OMB Control No: 2900-0712	ICR Reference No: 202102-2900-017
Status: Historical Inactive	Previous ICR Reference No: 201710-2900-010
Agency/Subagency: VA	Agency Tracking No: 2900-0712
Title: 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OIRA Conclusion Action: Withdrawn	Conclusion Date: 02/07/2022
	Date Received in OIRA: 11/08/2021
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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

IC Title	Form No.	Form Name
SHEP - Nationwide Customer Satisfaction Surveys	VA Form 10-1465-9, VA Form 10-1465-1, VA Form10-1465-3, VA Form 10-1465-4, VA Form 10-1465-6, VA Form 10-1465-11, VA Form 10-1465-2, VA Form 10-1465-7, VA Form 10-1465-5, VA Form 10-1465-8, VA Form 10-1465-10	, , , , , , , , , ,

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? No

Agency Contact: Frances O'Donnell 703 405-2449 fran.odonnell@cathexiscorp.com

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