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.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0770 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-0548 Community Living Center (CLC) Satisfaction Survey Community Living Center (CLC) Satisfaction Survey; Cardiac Cath Lab Satisfaction Survey; Psychiatric Patient Survey	Form
Form VA Form 10-0547 Cardiac Cath Lab Customer Satisfaction Survey Community Living Center (CLC) Satisfaction Survey; Cardiac Cath Lab Satisfaction Survey; Psychiatric Patient Survey	Form
Form VA Form 10-0550 Psychiatric Patient Satisfaction Survey Community Living Center (CLC) Satisfaction Survey; Cardiac Cath Lab Satisfaction Survey; Psychiatric Patient Survey	Form
VA Form 10-0548 Community Living Center (CLC) Satisfaction Survey CLC Resident Survey 10-0548.docx	Form
VA Form 10-0547 Cardiac Cath Lab Customer Satisfaction Survey Cath Lab Satisfaction Survey 10-0547 (2).docx	Form
VA Form 10-0550 Psychiatric Patient Satisfaction Survey Psychiatric Patient Satisfaction Survey 10-0550.pdf	Form
Generic Request Community Center Patient Survey .docx Community Livinig (CLC) Satisfaction Survey	IC Document
Generic Request_Cardiac Cath Lab Survey.docx Cardiac Cath Lab Customer Satisfaction Survey	IC Document
Generic Request_Psychiatric Patient Satisfaction Survey.docx Psychiatric Patient Satisfaction Survey	IC Document

IC Title:

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

Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.8(d)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Electronic Capability
Form	VA Form 10-0548	No	Paper Only
Form	VA Form 10-0547	No	Paper Only
Form	VA Form 10-0550	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 875

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	875	875
Annual IC Time Burden (Hours)	64	64
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Community Livinig (CLC) Satisfaction Survey		05/15/2012
Cardiac Cath Lab Customer Satisfaction Survey		05/14/2012
Psychiatric Patient Satisfaction Survey		05/14/2012

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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