VCP_VACC Provider Survey

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⚠️ Notice: This information collection may be referencing outdated material.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 10-1500210(WS) VCP_VACC Provider Survey Form and Instruction
Survey Invitation_Instructions.docx Instruction
Survey Reminder Letter.docx Other-Reminder Letter
10-1500210(WS) VACC Provider Survey VACC Provider Satisfaction Survey Instrument 20161207.docx Form and Instruction
10-1500209(WS) VCP Provider Survey VCP Provider Satisfaction Survey Instrument 20171207.docx Form and Instruction
VCP Provider Satisfaction Survey ICR 20161207 - Generic Request.docx Generic Request_VCP IC Document
VACC Provider Satisfaction Survey ICR 20161207 - Generic Request.docx Generic Reuqest_VACC IC Document

Information Collection (IC) Details

IC Title:	VCP_VACC Provider Survey	Agency IC Tracking Number:	2900-0770

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10-1500210(WS)	VACC Provider Survey	VACC Provider Satisfaction Survey Instrument 20161207.docx	Yes	Yes	Fillable Printable
Form and Instruction	10-1500209(WS)	VCP Provider Survey	VCP Provider Satisfaction Survey Instrument 20171207.docx	Yes	Yes	Fillable Printable
Instruction			Survey Invitation_Instructions.docx	No		Paper Only
Other-Reminder Letter			Survey Reminder Letter.docx	No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 4,000	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	4,000	4,000
Annual IC Time Burden (Hours)	667	667
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Request_VCP	VCP Provider Satisfaction Survey ICR 20161207 - Generic Request.docx	12/21/2016
Generic Reuqest_VACC	VACC Provider Satisfaction Survey ICR 20161207 - Generic Request.docx	12/14/2016

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