OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Community Living Center (CLC) Satisfaction Survey; Cardiac Cath Lab Satisfaction Survey; Psychiatric Patient Survey

IC 202280 under ICR 201403-2900-007 · OMB 2900-0770.

Documents and Forms
Document Name
Document Type
Form
Form
Form
Form
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Community Living Center (CLC) Satisfaction Survey; Cardiac Cath Lab Satisfaction Survey; Psychiatric Patient Survey
 
Modified
 
Voluntary
 
5 CFR 1320.8(d)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 10-0548 Community Living Center (CLC) Satisfaction Survey CLC Resident Survey 10-0548.docx No   Paper Only
Form VA Form 10-0547 Cardiac Cath Lab Customer Satisfaction Survey Cath Lab Satisfaction Survey 10-0547 (2).docx No   Paper Only
Form VA Form 10-0550 Psychiatric Patient Satisfaction Survey Psychiatric Patient Satisfaction Survey 10-0550.pdf No   Paper Only

Health Health Care Services

 

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 875 0 0 0 0 875
Annual IC Time Burden (Hours) 64 0 0 0 0 64
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Community Livinig (CLC) Satisfaction Survey Generic Request Community Center Patient Survey .docx 05/15/2012
Cardiac Cath Lab Customer Satisfaction Survey Generic Request_Cardiac Cath Lab Survey.docx 05/14/2012
Psychiatric Patient Satisfaction Survey Generic Request_Psychiatric Patient Satisfaction Survey.docx 05/14/2012
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.