NAC Customer Response Survey

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

TITLE OF INFORMATION COLLECTION:

NAC Customer Response Survey

PURPOSE:

The National Acquisition Center Survey is information that will be gathered and used by the National Acquisition Center’s senior staff to assess customer satisfaction with delivered products/services of the VA’s various Federal Supply Schedules, National Contracts, Blanket Purchase Agreements, and other national contract programs.

DESCRIPTION OF RESPONDENTS:

Respondents are Federal customers of the VA’s various Federal Supply Schedules, National Contracts, Blanket Purchase Agreements, and other national contract programs that relate to medical, surgical, pharmaceutical, patient Mobility devices, dental, laboratory, and medical services, and the vendors that supply the aforementioned items.

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: Raymond E. Schraeder

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

Personally Identifiable Information:

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

2. If Yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [ X ] 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	Participation Time ( × minutes =)	Burden (÷ 60 =)
VA Form	1000	5	83
Totals			83

FEDERAL COST: The estimated annual cost to the Federal government is $3,486.00.

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? [ ] Yes [ X] 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? No respondents are selected, they are given the opportunity to respond to the survey and only do so if they desire. There is no requirement that anyone respond at any time.

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

[ ] 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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