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Federal forms, ICRs, and supporting documents

Information Collection

Clinical Video Telehealth (CVT) Patient Satisfaction Survey

IC 199625 under ICR 201107-2900-001 · OMB 2900-0770.

Documents and Forms
Document Name
Document Type
Form
Form
IC Document
Information Collection (IC) Details

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Clinical Video Telehealth (CVT) Patient Satisfaction Survey 2900-0770
 
New
 
Voluntary
 
5 CFR 1320.8(d)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 10-0481a Clinical Video Telehealth (CVT) Patient Satisfaction Survey Clinical Video Telehealth (CVT) Patient Survey_ VA Form 10-0481a.docx No   Paper Only

Health Health Care Services

 

2,500 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,500 0 2,500 0 0 0
Annual IC Time Burden (Hours) 125 0 125 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Clinical Video Telehealth (CVT) Patient Satisfaction Survey Request_for_Generic_Clearance_Clinical_Video_Telehealth_Survey(v2)1.docx 10/17/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.