Health Research Multilevel Engagement, SORCC Patient Survey,

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA, VBA, VHA)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 10-10142 Health Research Multilevel Engagement, SORCC Patient Survey, Form and Instruction
10-10142 Womens Health Research Network Womens Health Research Network.docx Form and Instruction
10-10145 SOU-SORCC Patient Survey SOU-SORCC-Patient-Survey-2.docx Form and Instruction
2900-0770 State Veterans Home Patient Satisfaction SVH Questions.docx Form and Instruction
10-10147 VHA OSI Primary Care Survey VHA_OSI Conjoint_Primary Care_Survey_11-21-14 Final.doc Form and Instruction
Generic_Clearance_Submission_HAMILTON 091514 patients only_AH.docx Womens Health Research IC Document
VA SORCC Request 9 5 14.docx SORCC Request IC Document
Generic_Clearance SVH Satisfaction.docx SVH Satisfaction IC Document
VA Generic Fast-Track Clearance Request_VHA OSI Primary Care Conjoint Analysis_11 21 14.docx OSI Primary Care Fast Track Request IC Document

Information Collection (IC) Details

IC Title:	Health Research Multilevel Engagement, SORCC Patient Survey,	Agency IC Tracking Number:	2900-0770

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	10-10142	Womens Health Research Network	Womens Health Research Network.docx	No	Fillable Printable
Form and Instruction	10-10145	SOU-SORCC Patient Survey	SOU-SORCC-Patient-Survey-2.docx	No	Fillable Printable
Form and Instruction	2900-0770	State Veterans Home Patient Satisfaction	SVH Questions.docx	No	Fillable Printable
Form and Instruction	10-10147	VHA OSI Primary Care Survey	VHA_OSI Conjoint_Primary Care_Survey_11-21-14 Final.doc	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,477	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,477	4,477
Annual IC Time Burden (Hours)	1,067	1,067
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Womens Health Research	Generic_Clearance_Submission_HAMILTON 091514 patients only_AH.docx	09/23/2014
SORCC Request	VA SORCC Request 9 5 14.docx	09/23/2014
SVH Satisfaction	Generic_Clearance SVH Satisfaction.docx	09/23/2014
OSI Primary Care Fast Track Request	VA Generic Fast-Track Clearance Request_VHA OSI Primary Care Conjoint Analysis_11 21 14.docx	12/19/2014

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