Information Collection

VISN 1 Call Center Customer Service Survey / OKC HB Primary Care Satisfaction Survey

IC 210436 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⚠️ Notice: This information collection may be referencing outdated material.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 10-211014a Oklahoma City VAMC Home Based Primary Care (HBPC) Program VISN 1 Call Center Customer Service Survey / OKC HB Primary Care Satisfaction Survey	Form
VISN 1 Call Center Script and Survey.docx	Other-Script / Survey
VA Form 10-211014a Oklahoma City VAMC Home Based Primary Care (HBPC) Progra OKC PrimaryCareSurvey_10-211014A.pdf	Form
VISN 1 Call Center Customer Service Survey Generic_Submission.docx VISN 1 Call Center Customer Service Survey Generic Submission	IC Document
Generic Request_OKC HB Primary Care Satisfaction Survey.docx Generic Request OKC HB Primary Care Satisfaction Survey	IC Document

IC Title:

VISN 1 Call Center Customer Service Survey / OKC HB Primary Care 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
Other-Script / Survey				Telephonic Survey	No		Paper Only
Form	VA Form 10-211014a				No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,350

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	4,350	4,350
Annual IC Time Burden (Hours)	314	314
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
VISN 1 Call Center Customer Service Survey Generic Submission		02/20/2014
Generic Request OKC HB Primary Care Satisfaction Survey		02/20/2014

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

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