OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Childcare Service Satisfaction Survey; Purchased Care Online Survey; VHA ORD Focus Group Request; Teleretinal Patient Satisfaction Survey; Spinal Cord Home Care Satisfaction Survey

IC 200925 under ICR 201403-2900-007 · OMB 2900-0770.

Documents and Forms
Document Name
Document Type
Form
Other-Moderator Script
Other-Participant screener script
Form
Form
Form
Form
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Childcare Service Satisfaction Survey; Purchased Care Online Survey; VHA ORD Focus Group Request; Teleretinal Patient Satisfaction Survey; Spinal Cord Home Care Satisfaction Survey
 
Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 10-0531 Childcare Services Satisfaction Survey Childcare Services Satisfaction Survey 10-0531.docx No   Paper Only
Form VA Form 10-0538 Purchased Care Patient Satisfaction Survey Purchased Care Patient Satisfaction Survey_10-0538.docx URL To Be Determined Yes Yes Fillable Fileable
Form VA Form 10-0540 Teleretinal Patient Satisfaction Survey TeleRetinal Patient Survey_10-0540.pdf No   Paper Only
Form VA Form 10-0542 Spinal Cord Home Care Survey Spinal Cord Home Care Survey 10-0542.doc No   Paper Only
Other-Moderator Script VHA_ORD_Focus Group Moderators Guide_2_2012.doc No   Paper Only
Other-Participant screener script VHA ORD Focus Group Participant Screener 3_2012.doc Telephonic Screening Call No   Paper Only

Health Health Care Services

 

30,875 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 30,875 0 0 0 0 30,875
Annual IC Time Burden (Hours) 1,883 0 0 0 0 1,883
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Childcare Generic_Clearance_Submission Childcare Generic_Clearance_Submission.docx 01/27/2012
Purchased Care Online Survey_Generic Request Purchased Care Online Survey_Generic Request(v4).docx 02/17/2012
Teleretinal_Generic_Clearance_Submission Teleretinal_Generic_Clearance_Submission.docx 01/27/2012
Spinal Cord home Care Survey Generic_Request Spinal Cord home Care Survey Generic_Request.docx 01/27/2012
Focus Groups Soliciting feedback on VA Research Communication VHA ORD Generic Clearance_Request__3_7_2012.doc 03/07/2012
ORD Informed Consent VA ORD_Informed_Consent_Form (4).docx 02/27/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.