Information Collection

Community Living Center (CLC) Satisfaction Survey; Cardiac Cath Lab Satisfaction Survey; Psychiatric Patient Survey

IC 202280 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⚠️ Notice: This information collection may be referencing outdated material.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 10-0548 Community Living Center (CLC) Satisfaction Survey; Cardiac Cath Lab Satisfaction Survey; Psychiatric Patient Survey	Form
VA Form 10-0548 Community Living Center (CLC) Satisfaction Survey CLC Resident Survey 10-0548.docx	Form
VA Form 10-0547 Cardiac Cath Lab Customer Satisfaction Survey Cath Lab Satisfaction Survey 10-0547 (2).docx	Form
VA Form 10-0550 Psychiatric Patient Satisfaction Survey Psychiatric Patient Satisfaction Survey 10-0550.pdf	Form
Generic Request Community Center Patient Survey .docx Community Livinig (CLC) Satisfaction Survey	IC Document
Generic Request_Cardiac Cath Lab Survey.docx Cardiac Cath Lab Customer Satisfaction Survey	IC Document
Generic Request_Psychiatric Patient Satisfaction Survey.docx Psychiatric Patient Satisfaction Survey	IC Document

IC Title:

Community Living Center (CLC) Satisfaction Survey; Cardiac Cath Lab Satisfaction Survey; Psychiatric Patient Survey

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	Available Electronically?	Electronic Capability
Form	VA Form 10-0548	Community Living Center (CLC) Satisfaction Survey	CLC Resident Survey 10-0548.docx	No	Paper Only
Form	VA Form 10-0547	Cardiac Cath Lab Customer Satisfaction Survey	Cath Lab Satisfaction Survey 10-0547 (2).docx	No	Paper Only
Form	VA Form 10-0550	Psychiatric Patient Satisfaction Survey	Psychiatric Patient Satisfaction Survey 10-0550.pdf	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 875

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	875	875
Annual IC Time Burden (Hours)	64	64
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Community Livinig (CLC) Satisfaction Survey	Generic Request Community Center Patient Survey .docx	05/15/2012
Cardiac Cath Lab Customer Satisfaction Survey	Generic Request_Cardiac Cath Lab Survey.docx	05/14/2012
Psychiatric Patient Satisfaction Survey	Generic Request_Psychiatric Patient Satisfaction Survey.docx	05/14/2012

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