Information Collection

Veterans Experience Appointment Schedule Survey

IC 226359 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⚠️ Notice: This information collection may be referencing outdated material.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
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

IC Title:

Veterans Experience Appointment Schedule Survey

Agency IC Tracking Number:

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
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 %

table that charts list of burden
	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

table that charts IC Documents
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.