Information Collection

Patient Satisfaction Questionnaire: Network Consolidated Laboratory (NCL) Phlebotomy Service

IC 199626 under ICR 201107-2900-001 · OMB 2900-0770.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0770 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-0516 Patient Satisfaction Questionnaire: Network Consolidated Laboratory (NCL) Phlebotomy Service	Form
VA Form 10-0516 Patient Satisfaction Questionnaire: Laboratory P&LMS VA NCL Patient Satisfaction Questionnaire 6- 2011.doc	Form
Network_Consolidated__Lab_Generic_Clearance_Submission(v2)1.docx Patient Satisfaction Questionnaire Network Consolidated Laboratory (NCL) Phlebotomy Service	IC Document

IC Title:

Patient Satisfaction Questionnaire: Network Consolidated Laboratory (NCL) Phlebotomy Service

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.8(d)

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 10-0516	Patient Satisfaction Questionnaire: Laboratory P&LMS VA New England Healthcare System	NCL Patient Satisfaction Questionnaire 6- 2011.doc		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,600

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	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,600	1,600
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Patient Satisfaction Questionnaire Network Consolidated Laboratory (NCL) Phlebotomy Service	Network_Consolidated__Lab_Generic_Clearance_Submission(v2)1.docx	10/28/2011

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