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⚠️ Notice: This information collection may be referencing outdated material.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

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:

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

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 %

	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

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.