Care Coordination Home Telehealth Patient Satisfaction Survey

Care Coordination Home Telehealth (CCHT) Patient Satisfaction Survey

Documents and Forms

Document Name Document Type
Form 10-0341 Care Coordination Home Telehealth Patient Satisfaction Survey Form and Instruction
10-0341 VHA Telehealth Services HT Patient Satisfaction Survey VHA Telehealth Services HT Patient Satisfaction Survey with VE questions.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Care Coordination Home Telehealth Patient Satisfaction Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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
Form and Instruction	10-0341	VHA Telehealth Services HT Patient Satisfaction Survey	VHA Telehealth Services HT Patient Satisfaction Survey with VE questions.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	65,600	65,600
Annual IC Time Burden (Hours)	1,640	1,640
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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