Information Collection

Patient Satisfaction Surveys: Radiation Oncology/VISN 12 Telephone Care Service

IC 206725 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⚠️ Notice: This information collection may be referencing outdated material.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 10-10063 Patient Satisfaction Surveys: Radiation Oncology/VISN 12 Telephone Care Service	Form
VA Form 10-10063 Patient Satisfaction Survey- Radiation Oncology VA Radiation Onc Patient Survey 10-10063.pdf	Form
VA Form 10-10058 Telephone Care Services Patient Satisfaction Survey Telephone Care Service Survey 10-10058.pdf	Form
OKCVA Radiation Oncology Generic_Submission.docx OKCVA Radiation Oncology Satisfaction Survey	IC Document
Generic_Submission_VISN 12 Tele Care Services Survey.docx VISN 12 Telephone Care Services Satisfaction Survey	IC Document

IC Title:

Patient Satisfaction Surveys: Radiation Oncology/VISN 12 Telephone Care Service

Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 10-10063	Patient Satisfaction Survey- Radiation Oncology	VA Radiation Onc Patient Survey 10-10063.pdf		No		Paper Only
Form	VA Form 10-10058	Telephone Care Services Patient Satisfaction Survey	Telephone Care Service Survey 10-10058.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 560

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	560	560
Annual IC Time Burden (Hours)	66	66
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OKCVA Radiation Oncology Satisfaction Survey	OKCVA Radiation Oncology Generic_Submission.docx	04/30/2013
VISN 12 Telephone Care Services Satisfaction Survey	Generic_Submission_VISN 12 Tele Care Services Survey.docx	04/30/2013

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