Information Collection

VCP_VACC Provider Survey

IC 224796 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⚠️ Notice: This information collection may be referencing outdated material.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 10-1500210(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

IC Title:

VCP_VACC Provider 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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.