Information Collection

Generic Veterans Health Administration Customer Satisfaction Surveys

IC 44127 under ICR 200708-2900-004 · OMB 2900-0570.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0570 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
My HealtheVet Pilot Survey Veteran Questionnaire 2007[1].doc www.myhealth.va.gov	Other-Survey
My HealtheVet Survey Questions for SHEP 2007[1].doc www.myhealth.va.gov	Other-Survey

IC Title:

Generic Veterans Health Administration Customer Satisfaction Surveys

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			My HealtheVet Pilot Survey Veteran Questionnaire 2007[1].doc	www.myhealth.va.gov	Yes	Yes	Fillable Fileable
Other-Survey			My HealtheVet Survey Questions for SHEP 2007[1].doc	www.myhealth.va.gov	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 531,144

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,074,901	1,074,901
Annual IC Time Burden (Hours)	130,644	130,644
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.