Information Collection

DeBakey Home Care Satisfaction Survey / CPEP Veterans Satisfaction Survey

IC 206447 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⚠️ Notice: This information collection may be referencing outdated material.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 10-0476 DeBakey Home Care Satisfaction Survey / CPEP Veterans Satisfaction Survey	Form and Instruction
VA Form 10-0476 Michael E. DeBakey Patient Satisfaction Survey DeBakey Survey 10-0476.pdf Facilitated telephonic survey	Form and Instruction
VA Form 10-0480 Compensation and Pension Examination Program (CPEP) Vete CPEP Veterans Survey 10-0480.pdf To Be Determined	Form
Generic_Submission_M.E.DeBakey Patient Satisfaction.docx Michael E. DeBakey Home Care Program Patient Satisfaction Survey	IC Document
Generic_Submission_(CPEP) Veterans Satisfaction Survey.docx Compensation & Pension Examination Program (CPEP) Veterans Survey	IC Document

IC Title:

DeBakey Home Care Satisfaction Survey / CPEP Veterans Satisfaction Survey

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 and Instruction	VA Form 10-0476	Michael E. DeBakey Patient Satisfaction Survey	DeBakey Survey 10-0476.pdf	Facilitated telephonic survey	No		Paper Only
Form	VA Form 10-0480	Compensation and Pension Examination Program (CPEP) Veterans Satisfaction Survey	CPEP Veterans Survey 10-0480.pdf	To Be Determined	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,055

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	1,714	1,714
Annual IC Time Burden (Hours)	170	170
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Michael E. DeBakey Home Care Program Patient Satisfaction Survey	Generic_Submission_M.E.DeBakey Patient Satisfaction.docx	04/11/2013
Compensation & Pension Examination Program (CPEP) Veterans Survey	Generic_Submission_(CPEP) Veterans Satisfaction Survey.docx	04/11/2013

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