Veterans Experience Appointment Schedule 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⚠️ Notice: This information collection may be referencing outdated material.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
VA AppointmentSurveyQuestions_04APR17.pdf URL To be established Other-eSurvey
Email Invite VE Appointment Survey 11APR17.pdf URL to be established Other-Email Invite
VE Appointment Scheduling Survey_Generic Request APR2017.docx Veterans Experience Appointment Scheduling Survey IC Document

Information Collection (IC) Details

IC Title:	Veterans Experience Appointment Schedule Survey	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
Other-eSurvey			VA AppointmentSurveyQuestions_04APR17.pdf	URL To be established	Yes	Yes	Fillable Fileable
Other-Email Invite			Email Invite VE Appointment Survey 11APR17.pdf	URL to be established	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100,000	100,000
Annual IC Time Burden (Hours)	1,667	1,667
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Veterans Experience Appointment Scheduling Survey	VE Appointment Scheduling Survey_Generic Request APR2017.docx	04/12/2017

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