Information Collection

Customer Satisfaction Survey for Nutrition and Food Service

IC 44124 under ICR 200907-2900-005 · OMB 2900-0227.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0227 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-5387 Customer Satisfaction Survey for Nutrition and Food Service	Form
VA Form 10-5387 Customer Satisfaction Survey for Nutrition and Food Serv vha-10-5387.pdf vaww.va.gov/vaforms/medical/pdf/vha-10-5387.pdf	Form

IC Title:

Customer Satisfaction Survey for Nutrition and Food Service

Agency IC Tracking Number:

2900-0227

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
Form	VA Form 10-5387	Customer Satisfaction Survey for Nutrition and Food Service	vha-10-5387.pdf	http://vaww.va.gov/vaforms/medical/pdf/vha-10-5387.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 31,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	125,600	-394,800	520,400
Annual IC Time Burden (Hours)	4,187	-195,720	199,907
Annual IC Cost Burden (Dollars)	0	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.