Information Collection

Veterans Experience Appointment Schedule Survey (Rev)

IC 227343 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⚠️ Notice: This information collection may be referencing outdated material.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.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

IC Title:

Veterans Experience Appointment Schedule Survey (Rev)

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-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 %

table that charts list of burden
	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

table that charts IC Documents
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.