Information Collection

Care Coordination Home Telehealth Patient Satisfaction Survey

IC 191713 under ICR 201308-2900-016 · OMB 2900-0766.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0766 can be found here:

Documents and Forms

Document Name Document Type
Form 10-0341 Care Coordination Home Telehealth Patient Satisfaction Survey Form
10-0341 Care Coordination Home Telehealth (CCHT) Patient Satisfa Telehealth Survey VA Form 10-0481_20140314.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Care Coordination Home Telehealth Patient Satisfaction Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	10-0341	Care Coordination Home Telehealth (CCHT) Patient Satisfaction Survey	Telehealth Survey VA Form 10-0481_20140314.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	65,600	65,600
Annual IC Time Burden (Hours)	1,640	1,640
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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