Information Collection

Extended Hours Program Evaluation, Maternity Care Coordination, Advanced Education Veteran Survey, State Veterans Home Administrator Survey, VOV Conjoint Survey

IC 213752 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⚠️ Notice: This information collection may be referencing outdated material.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 10-10129 Extended Hours Program Evaluation, Maternity Care Coordination, Advanced Education Veteran Survey, State Veterans Home Administrator Survey, VOV Conjoint Survey	Form and Instruction
10-10129 Extended Hours Evaluation - Non-Users Extended Hours Program Evaluation - Non-Users Survey_v2-2.docx	Form and Instruction
10-10132 Extended Hours Evaluation - Users Extended Hours Program Evaluation - Users Survey_v2-1.docx	Form and Instruction
10-10131 Maternity Care Coordination Survey Maternity Care Coordination Survey_FINAL_Mattocks (3).docx	Form and Instruction
10-10128 Advanced Education Veteran Survey SOU-SORCC-Patient-Survey.docx	Form and Instruction
10-10136 State Veterans Home Admin Survey SVH Admin Survey.docx	Form and Instruction
10-10144 Voice of the Veteran (VOV) Satisfaction Survey Office of VHA_OSI Conjoint_Primary Care_Survey_11-21-14 Final (1) (CR 12 29 14).doc	Form and Instruction
Generic_Clearance_Submission_SVH Survey.docx Generic Clearance - State Veterans Home	IC Document
VA SORCC Request 9 5 14.docx Advanced Education Survey Request	IC Document
VA SORCC Request 9 5 14.docx Advanced Education Survey Request	IC Document
Generic_Clearance_Submission_SVH Survey.docx Generic Clearance - State Veterans Home	IC Document
VISN1EHProgram_VA Generic Fast-Track Clearance Request.docx V1 Extended Hours Generic Clearance	IC Document
VA Generic Fast-Track Clearance Request Template_Mattocks_Maternity Care Coordination.docx VA Maternity Care Coordination Generic Clearance	IC Document
VA Generic Fast-Track Clearance Request_VHA OSI Primary Care Conjoint Analysis_11 21 14.docx ICR Request Voice of the Veteran (VOV) Satisfaction Survey Office of Strategic Integration (OSI) Conjoint Analysis	IC Document
IOM Conjoint Survey Fast Track Request White Paper (3) (CR 12 29 14).docx Fast Track Review Request	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Extended Hours Program Evaluation, Maternity Care Coordination, Advanced Education Veteran Survey, State Veterans Home Administrator Survey, VOV Conjoint Survey

Agency IC Tracking Number:

2900-0770

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form and Instruction	10-10129	Extended Hours Evaluation - Non-Users	Extended Hours Program Evaluation - Non-Users Survey_v2-2.docx	No	Fillable Printable
Form and Instruction	10-10132	Extended Hours Evaluation - Users	Extended Hours Program Evaluation - Users Survey_v2-1.docx	No	Fillable Printable
Form and Instruction	10-10131	Maternity Care Coordination Survey	Maternity Care Coordination Survey_FINAL_Mattocks (3).docx	No	Fillable Printable
Form and Instruction	10-10128	Advanced Education Veteran Survey	SOU-SORCC-Patient-Survey.docx	No	Fillable Printable
Form and Instruction	10-10136	State Veterans Home Admin Survey	SVH Admin Survey.docx	No	Fillable Printable
Form and Instruction	10-10144	Voice of the Veteran (VOV) Satisfaction Survey Office of Strategic Integration (OSI) Conjoint Analysis	VHA_OSI Conjoint_Primary Care_Survey_11-21-14 Final (1) (CR 12 29 14).doc	No	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,840

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,840	1,840
Annual IC Time Burden (Hours)	521	521
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Clearance - State Veterans Home	Generic_Clearance_Submission_SVH Survey.docx	11/05/2014
Advanced Education Survey Request	VA SORCC Request 9 5 14.docx	11/05/2014
Advanced Education Survey Request	VA SORCC Request 9 5 14.docx	11/05/2014
Generic Clearance - State Veterans Home	Generic_Clearance_Submission_SVH Survey.docx	11/05/2014
V1 Extended Hours Generic Clearance	VISN1EHProgram_VA Generic Fast-Track Clearance Request.docx	11/05/2014
VA Maternity Care Coordination Generic Clearance	VA Generic Fast-Track Clearance Request Template_Mattocks_Maternity Care Coordination.docx	11/05/2014
ICR Request Voice of the Veteran (VOV) Satisfaction Survey Office of Strategic Integration (OSI) Conjoint Analysis	VA Generic Fast-Track Clearance Request_VHA OSI Primary Care Conjoint Analysis_11 21 14.docx	12/22/2014
Fast Track Review Request	IOM Conjoint Survey Fast Track Request White Paper (3) (CR 12 29 14).docx	12/29/2014

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