Customer Satisfaction Survey for Claims Clinics Pilot Program

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⚠️ Notice: This information collection may be referencing outdated material.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
Claims Clinic Veteran Satisfaction Survey.docx Other-survey
VA Generic Fast-Track Clearance Request Template Claims Clinics 2.docx Generic Fast-Track Clearence Request IC Document

Information Collection (IC) Details

IC Title:	Customer Satisfaction Survey for Claims Clinics Pilot Program	Agency IC Tracking Number:	2900-0770

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.9

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-survey			Claims Clinic Veteran Satisfaction Survey.docx		No		Paper Only

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	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	2,000	2,000
Annual IC Time Burden (Hours)	333	333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Fast-Track Clearence Request	VA Generic Fast-Track Clearance Request Template Claims Clinics 2.docx	10/06/2015

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