Compensation & Pension Examination Program (CPEP) Veterans Survey

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 2900-0770)

TITLE OF INFORMATION COLLECTION:

Compensation and Pension Examination Program (CPEP)
Veterans Satisfaction Survey

PURPOSE:

In response to Executive Order 12862, the Veterans Health Administration (VHA) conducts both centrally and locally administered surveys to determine the level of satisfaction with existing services among VHA's customers. The surveys solicit voluntary opinions and are not intended to collect information required to obtain or maintain eligibility for a Department of Veterans Affairs (VA) program or benefit. The Compensation and Pension Examination Program (CPEP) is constantly striving to improve the service we provide to our nation’s Veterans.

CPEP’s goal is to gather and report information about Veterans’ compensation and pension experiences at individual exam sites to provide feedback to the sites in order to improve this experience for all Veterans. CPEP will allow Veterans an opportunity to provide anonymous feedback on how well the exam process is perceived by Veterans undergoing these exams. CPEP uses this feedback to improve the compensation and pension exam processes. VA uses the information gathered to determine where and to what extent services are satisfactory, and where and to what extent they are in need of improvement. The information may lead to policy changes, which improve Veteran satisfaction with VA Healthcare benefits.

DESCRIPTION OF RESPONDENTS:

The CPEP Veterans’ Satisfaction Survey will be given to Veterans inviting them to participate in a survey that addresses VHA’s Compensation & Pension exam process. This will be an ongoing survey that will be offered to Veterans on a monthly basis. The probability of Veterans having access to the public internet is unknown; therefore the Veterans will have an option to receive a paper copy of the survey to complete. The survey will be distributed through Compensation & Pension departments at the time of their exams. Veterans will be given an opportunity to complete the survey and return it to the Compensation & Pension clerk, or they can mail the survey to our collection center. There will be an online opportunity to fill out a survey as well, and Veterans choosing that option will be provided with a web-link to the survey site.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [x] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [ ] Other: ______________________

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name:_Dennis Boyette, Health Eligibility Center, Atlanta, GA

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [X] No

2. If Yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [X] No

BURDEN HOURS

Category of Respondent Individuals & Households	No. of Respondents	No. of Responses	Participation Time	Burden
VA Form 10-0480	1055	1.53	5.7	153
Totals				153

FEDERAL COST: The estimated annual cost to the Federal government is $3,500 per year.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [X] Yes [ ] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

Veteran patient population 24,000,000

Potential respondent universe: 600,000 patients/year

Sample Size 1055

A random sample is derived based on the scheduled CPEP examination. It is expected that the response rate will be 50%. This is based on previous data collections conducted by VHA. At the present time, CPEP examination visits are not individually identified in a database where a random sample query could be used. Therefore the random sample will be based upon a rotating distribution of the survey materials at time of examination and administered at each clinic.

Veterans will be given a copy of the survey with a Business Reply postage paid envelope. They will also be provided a link to an on-line version of the survey. Providing flexibility in the method of survey completion will provide the Veterans options that should increase the response rate. The assumed 50% response rate on 1055 surveys offered should yield results with approximately +/- 5% margin of error. Targeting the actual CPEP examination and not generalized healthcare outcomes yields increases validity of the data.

This is a relatively simple survey with 7 questions. The number of questions was kept to a minimum to reduce burden and improve response rates. Four questions are targeted toward CPEP specific requirements. The results of this survey will be used improve the Veteran experience with the CPEP process and provide a baseline for CPEP expansions and to help prepare for growth in the Veteran use of the CPEP process.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[X] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[X] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [X] No

Please make sure that all instruments, instructions, and scripts are submitted with the request.

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