Information Collection

VHA Generic Request: Notice Nurse Comment Card; Low Vision Clinic Patient Satisfaction Survey; Vendor Registration; Telephone Transformation Focus Group

IC 200161 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⚠️ Notice: This information collection may be referencing outdated material.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 10-0527 VHA Generic Request: Notice Nurse Comment Card; Low Vision Clinic Patient Satisfaction Survey; Vendor Registration; Telephone Transformation Focus Group	Form
Focus Group Discussion Guide_final_VA requested change 11-10-2011.pdf	Other-Script
VA Form 10-0527 PVAMC Low Vision Patient Satisfaction Survey PVAMC Advanced Low Vision Clinic QA Survey.docx	Form
VA form 10-0519 Notice Your Nurse Notice Your Nurse Comment Card 10-0519 (4).doc	Form
VA Form 10-0528 Vendor Application for Fair Vendor Application for Fair 10-0528.pdf [email protected]	Form
Generic_Clearance_Submission_PVAMC_LowVisionClinic.docx PVAMC Generic Request	IC Document
Notice your nurse Generic Clearance Request.docx Generic Clearance Request_Notice Your Nurse	IC Document
Generic_Submission_Vendor_Application for Fair.docx Generic Clearance Request_Vendor Application for Fair	IC Document
Generic_Clearance_Submission_Telephone Focus Groups_08-5-2011.pdf VHA Telephone Transformation Focus Groups	IC Document
Introduction Item List for focus groups_8511.pdf VHA Telephone Transformation Focus Groups	IC Document
Focus group protocol_2011.pdf VHA Telephone Transformation Focus Groups	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

VHA Generic Request: Notice Nurse Comment Card; Low Vision Clinic Patient Satisfaction Survey; Vendor Registration; Telephone Transformation Focus Group

Agency IC Tracking Number:

IC Status: New

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 10-0527	PVAMC Low Vision Patient Satisfaction Survey	PVAMC Advanced Low Vision Clinic QA Survey.docx		No		Paper Only
Form	VA form 10-0519	Notice Your Nurse	Notice Your Nurse Comment Card 10-0519 (4).doc		No		Paper Only
Form	VA Form 10-0528	Vendor Application for Fair	Vendor Application for Fair 10-0528.pdf	[email protected]	Yes	Yes	Fillable Fileable
Other-Script			Focus Group Discussion Guide_final_VA requested change 11-10-2011.pdf		No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 586

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	586	586
Annual IC Time Burden (Hours)	126	126
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
PVAMC Generic Request	Generic_Clearance_Submission_PVAMC_LowVisionClinic.docx	12/15/2011
Generic Clearance Request_Notice Your Nurse	Notice your nurse Generic Clearance Request.docx	12/15/2011
Generic Clearance Request_Vendor Application for Fair	Generic_Submission_Vendor_Application for Fair.docx	12/15/2011
VHA Telephone Transformation Focus Groups	Generic_Clearance_Submission_Telephone Focus Groups_08-5-2011.pdf	11/22/2011
VHA Telephone Transformation Focus Groups	Introduction Item List for focus groups_8511.pdf	11/22/2011
VHA Telephone Transformation Focus Groups	Focus group protocol_2011.pdf	11/22/2011

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