Information Collection

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

IC 208635 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⚠️ Notice: This information collection may be referencing outdated material.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 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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.