Information Collection

Vet Apptmnt Apps Satisfaction Srvy/Hem-Oncology Telehealth Satisfaction Svy

IC 206171 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⚠️ Notice: This information collection may be referencing outdated material.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
Vet Appt Mobile App Survey Form_10-10057.docx Web App URL TBD	Other-Mobile application
Hem-Oncology Telehealth Satisfaction Survey_10-10054 .doc TBD - Telemedicine Equipment	Other-Web-based
Procedure Script for Hem-Oncology Satisfaction Survey.docx	Instruction
Generic_Request_ Appointment Mobile App Survey.docx Veteran Appointment Mobile Application Satisfaction Survey request	IC Document
Hem-Oncology Telehealth Generic_Clearance_Submission.docx Patient Satisfaction Svy-Telemedicine/Hem Oncology Services	IC Document

IC Title:

Vet Apptmnt Apps Satisfaction Srvy/Hem-Oncology Telehealth Satisfaction Svy

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Mobile application	Vet Appt Mobile App Survey Form_10-10057.docx	Web App URL TBD	Yes	Yes	Fillable Fileable
Other-Web-based	Hem-Oncology Telehealth Satisfaction Survey_10-10054 .doc	TBD - Telemedicine Equipment	Yes	Yes	Fillable Fileable
Instruction	Procedure Script for Hem-Oncology Satisfaction Survey.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 430

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	430	430
Annual IC Time Burden (Hours)	36	36
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Veteran Appointment Mobile Application Satisfaction Survey request	Generic_Request_ Appointment Mobile App Survey.docx	03/22/2013
Patient Satisfaction Svy-Telemedicine/Hem Oncology Services	Hem-Oncology Telehealth Generic_Clearance_Submission.docx	03/22/2013

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