CONSUMER SAMPLING LETTER - VA HOSPITALS

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Forms and supporting documents for this ICR

Document	Type	Status	Availability

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Information collection document groups

IC ID	Collection	Type	Status	Form
147514	CONSUMER SAMPLING LETTER - VA HOSPITALS	Form	Migrated

ICR Details

OMB Control No: 2900-0190	ICR Reference No: 198408-2900-022
Status: Historical Inactive	Previous ICR Reference No: 198209-2900-032
Agency/Subagency: VA	Agency Tracking No:
Title: CONSUMER SAMPLING LETTER - VA HOSPITALS
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Disapproved	Conclusion Date: 09/26/1984
	Date Received in OIRA: 08/09/1984
Terms of Clearance: IN VIEW OF OTHER ACTIVITIES SPONSORED BY THE VA THAT GATHER PATIENT SATISFACTION DATA ON A MORE RIGOROUS BASIS, OMB CONSIDERS THIS DATA COLLECTION TO BE OF NEGLIGIBLE UTILITY. THE VA SHOULD INSTRUCT ALL HOSPITALS TO CEASE USING THIS FORM IMMEDIATELY. OMB WOULD CONSIDER A REQUEST TO ADD THESE QUESTIONS TO OTHER DATA COLLECTION INSTRUMENTS SUCH AS THE 10-1465 A AND B.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		07/31/1984
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: THIS LETTER IS NEEDED TO HELP DETERMINE THE QUALITY OF VETERANS ASSISTANCE SERVICES GIVEN TO PATIENTS IN VA MEDICAL CENTERS.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
CONSUMER SAMPLING LETTER - VA HOSPITALS	VA FL, 27-652A

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 08/09/1984

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