National Patient Centered Community Care Survey Questions / Oklahoma City (OKC) VAMC Dental Patient Satisfaction Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA, VBA, VHA)

⚠️ Notice: This information collection may be referencing outdated material.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 10-211009 National Patient Centered Community Care Survey Questions / Oklahoma City (OKC) VAMC Dental Patient Satisfaction Survey Form
10-211009 National Patient Centered Community Care Veterans Survey VA Form 10-211009 PC3.pdf Form
10-211008 Dental (Ambulatory) Patient Satisfaction Survey OKC Patient Satisfaction Survey 10-211008.pdf Form
VA Generic_Clearance_Submission_PC3 Survey (v4).docx VA Generic Clearance Submission PC3 Survey IC Document
Generic Request OKC Patient Satisfaction.pdf Generic Request OKC Dental Satisfaction Survey IC Document

Information Collection (IC) Details

IC Title:	National Patient Centered Community Care Survey Questions / Oklahoma City (OKC) VAMC Dental Patient Satisfaction Survey	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	10-211009	National Patient Centered Community Care Veterans Survey Question	VA Form 10-211009 PC3.pdf	TBD	Yes	Yes	Fillable Fileable
Form	10-211008	Dental (Ambulatory) Patient Satisfaction Survey	OKC Patient Satisfaction Survey 10-211008.pdf		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 12,400	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	12,400	12,400
Annual IC Time Burden (Hours)	1,434	1,434
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
VA Generic Clearance Submission PC3 Survey	VA Generic_Clearance_Submission_PC3 Survey (v4).docx	09/19/2013
Generic Request OKC Dental Satisfaction Survey	Generic Request OKC Patient Satisfaction.pdf	09/12/2013

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