Information Collection

Primary Care Satisfaction Survey

IC 228035 under ICR 201404-2900-002 · OMB 2900-0769.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Patient Satisfaction Survey w Cover - VHA Pittsburgh 646 - Primary Care.pdf	Other-Survey
Generic Clearance Request - VHA Pittsburgh 646 - Primary Care.docx Primary Care 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-Survey			Patient Satisfaction Survey w Cover - VHA Pittsburgh 646 - Primary Care.pdf		No		Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,760

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	5,760	5,760
Annual IC Time Burden (Hours)	192	192
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Primary Care Satisfaction Survey	Generic Clearance Request - VHA Pittsburgh 646 - Primary Care.docx	08/25/2017

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