Information Collection

Generic Veterans Health Administration Customer Satisfaction Surveys

IC 44127 under ICR 200901-2900-012 · OMB 2900-0570.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
CCHT Electronic Survey Questions.doc To be determine	Other-survey

IC Title:

Agency IC Tracking Number:

2900-0570

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			CCHT Electronic Survey Questions.doc	To be determine	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 885,797

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	885,797	885,797
Annual IC Time Burden (Hours)	125,347	125,347
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.