Information Collection

VHA Pallative Care Telehealth Appointments / Mental Health Veterans Survey

IC 228034 under ICR 201404-2900-002 · OMB 2900-0769.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Pallative System Usability Scale and Demographic Qs_UX Pall Care UPDATED UNION OMB.pdf	Other-Usability scale
MH Veterans Satisfaction Survey.docx	Other-Survey
Generic Clearance Submission_Telehealth Appts.doc Veterans' and Providers' User Experience of Palliative Care Telehealth Appointments	IC Document
MH Veterans Satisfaction Generic Request_052417.docx Office of Mental Health Veteran Satisfaction Survey	IC Document

IC Title:

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-Usability scale			Pallative System Usability Scale and Demographic Qs_UX Pall Care UPDATED UNION OMB.pdf	TBD	Yes	No	Fillable Printable
Other-Survey			MH Veterans Satisfaction Survey.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,010

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	10,010	10,010
Annual IC Time Burden (Hours)	2,503	2,503
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Veterans' and Providers' User Experience of Palliative Care Telehealth Appointments	Generic Clearance Submission_Telehealth Appts.doc	08/24/2017
Office of Mental Health Veteran Satisfaction Survey	MH Veterans Satisfaction Generic Request_052417.docx	08/24/2017

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