Veterans Experience Initiative

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⚠️ Notice: This information collection may be referencing outdated material.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

Information Collection (IC) Details

IC Title:	Veterans Experience Initiative	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.