Information Collection

Veterans Experience Initiative

IC 219472 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⚠️ Notice: This information collection may be referencing outdated material.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 10-0516 Veterans Experience Initiative	Form and Instruction
10-0516 NCL Patient Satisfaction Questionnaire NCL Patient Satisfaction Questionnaire (OMB approved 8-31-2014) with mandatory VE-PRA updates 12-9-15 - 1.5.16.docx	Form and Instruction
10-0476 Michael E. DeBakey Home Care Program Patient satisfaction survey Instrument 2011 final approval new questions(v3) - 1.5.16.docx	Form and Instruction
VE_Non_Substantial_Change_White Paper _ Generic Clearance (3).docx White Paper	IC Document

IC Title:

Veterans Experience Initiative

Agency IC Tracking Number:

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
Form and Instruction	10-0516	NCL Patient Satisfaction Questionnaire	NCL Patient Satisfaction Questionnaire (OMB approved 8-31-2014) with mandatory VE-PRA updates 12-9-15 - 1.5.16.docx		No		Fillable Printable
Form and Instruction	10-0476	Michael E. DeBakey Home Care Program	Patient satisfaction survey Instrument 2011 final approval new questions(v3) - 1.5.16.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 491,126

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	491,126	491,126
Annual IC Time Burden (Hours)	8,185	8,185
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
White Paper	VE_Non_Substantial_Change_White Paper _ Generic Clearance (3).docx	01/05/2016

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