Information Collection

Mental Health - SORCC Satisfaction Survey

IC 222066 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⚠️ Notice: This information collection may be referencing outdated material.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
MHSL (VA SORCC - 692) Satisfaction Survey.docx	Instruction
Generic Clearance Submission Template (VA SORCC - 692) 062016.docx Generic Request for MH - SORCC	IC Document

IC Title:

Mental Health - SORCC Satisfaction 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
Instruction			MHSL (VA SORCC - 692) 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: 2,500

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	2,500	2,500
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Request for MH - SORCC	Generic Clearance Submission Template (VA SORCC - 692) 062016.docx	06/21/2016

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