Project ARCH Non-Participating 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:

Project ARCH Non-Participating Veterans Survey

PURPOSE:

The Department of Veterans Affairs (VA) is administering Project ARCH (Access Received Closer to Home), a congressionally mandated, three-year pilot program under Section 403 of Public Law 110-387, amended by Section 308 of Public Law 111-163. Veterans participating in Project ARCH receive health care services through contractual arrangements with non-VA providers. Project ARCH intends to improve access for participating Veterans by connecting them to these local providers closer to where Veterans live.

After the first 18 months of the pilot program, some Veterans who are eligible to participate in Project ARCH have not participated in the program. The purpose of the Project ARCH Non-Participating Veterans Survey is to gather information from these eligible Veterans regarding their reasons not to participate. Information gathered from the survey will be used to help inform VA Project ARCH staff about factors that influence participation in Project ARCH and aspects that can be improved to increase participation.

DESCRIPTION OF RESPONDENTS:

VA intends to survey Veterans eligible for receiving care under Project ARCH who have not participated in the pilot program. Project ARCH has specific eligibility criteria for Veterans to participate as outlined in the statute enacting the pilot program.

TYPE OF COLLECTION: (Check one)

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

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

[ ] Focus Group [X] Other: Non-participation survey

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: Colette Alvarez, Project ARCH Program Manager

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 or Households	No. of Respondents	Participation Time	Burden
VA Form 10-211004	2,040	15 minutes	510 hours
Totals			510 hrs

FEDERAL COST: The estimated annual cost to the Federal government is: $34,418.12

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

We have a list of all Veterans who, based on their home address, were eligible for Project ARCH when the program was initiated. From this list, we will identify the population of Veterans who have a need for care, but who have not received care through Project ARCH. Based on similar surveys we have conducted for VA, we expect our response rate to be above 50%. Since our goal is to have 2,000 completed responses (400 at each pilot site), we will randomly select 4,000 Veterans from this population to whom we will mail surveys.

Administration of the Instrument

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

[ ] 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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