Veterans Experience Appointment Schedule Survey (Rev)

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⚠️ Notice: This information collection may be referencing outdated material.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.pdf Evite URL Other-E-Survey
Email Invite VE Appointment Survey 11APR17.pdf Respondent Email Other-Evite_email
Revision - Justification_VE Appointment Scheduling SurveyJUN2017.docx Veterans Experience Access Survey Questions Scheduling Appointment. IC Document
White Paper Request for Burden Increase- VE Appointment Survey.docx White Paper Request for Burden Increase- VE Appointment Survey IC Document

Information Collection (IC) Details

IC Title:	Veterans Experience Appointment Schedule Survey (Rev)	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-E-Survey			VA AppointmentSurveyQuestions.pdf	Evite URL	Yes	Yes	Fillable Fileable
Other-Evite_email			Email Invite VE Appointment Survey 11APR17.pdf	Respondent Email	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,800,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 23 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,800,000	1,800,000
Annual IC Time Burden (Hours)	30,000	30,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Veterans Experience Access Survey Questions Scheduling Appointment.	Revision - Justification_VE Appointment Scheduling SurveyJUN2017.docx	06/30/2017
White Paper Request for Burden Increase- VE Appointment Survey	White Paper Request for Burden Increase- VE Appointment Survey.docx	06/30/2017

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