Information Collection

Customer Satisfaction Survey for Claims Clinics Pilot Program

IC 218510 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⚠️ Notice: This information collection may be referencing outdated material.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
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.