Information Collection

Health Advocate Survey

IC 218847 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⚠️ Notice: This information collection may be referencing outdated material.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
HA Patient Satisfaction Survey.docx	Other-Survey
Health Advocate - Generic Clearance Submission Request.doc VA Generic Clearance Request	IC Document
Health Advocate White Paper with Executive Summary - For HVAC 11-3-15.docx White Paper	IC Document

IC Title:

Health Advocate 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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			HA Patient Satisfaction Survey.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

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	50	50
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
VA Generic Clearance Request	Health Advocate - Generic Clearance Submission Request.doc	11/03/2015
White Paper	Health Advocate White Paper with Executive Summary - For HVAC 11-3-15.docx	11/03/2015

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