NOA 4-19-18 WhiteHouse HotlineCallSurvey

NOTICE OF OFFICE OF MANAGEMENT AND BUDGET ACTION
Date

04/19/2018

Department of Veterans Affairs

FOR CERTIFYING OFFICIAL:

Scott Blackburn

FOR CLEARANCE OFFICER:

Cynthia Harvey-Pryor

In accordance with the Paperwork Reduction Act, OMB has taken action on your request received
04/04/2018
ACTION REQUESTED: Generic IC
VE: White House Hotline VA Veterans Call Center Online/Phone Survey
IC TITLE:
ICR REFERENCE NUMBER:

201710-2900-001

AGENCY ICR TRACKING NUMBER:

2900-0770

TITLE:

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA,
VBA, VHA)
LIST OF INFORMATION COLLECTIONS: See next page
OMB ACTION: Approved without change
OMB CONTROL NUMBER:

2900-0770

The agency is required to display the OMB Control Number and inform respondents of its legal significance in
accordance with 5 CFR 1320.5(b).
EXPIRATION DATE: 09/30/2020

BURDEN:

DISCONTINUE DATE:

RESPONSES

HOURS

COSTS

Previous

335,000

214,167

0

New

335,000

300,000

0

Change due to New Statute

0

0

0

Change due to Agency Discretion

0

85,833

0

Change due to Agency Adjustment

0

0

0

Change due to PRA Violation

0

0

0

Difference

TERMS OF CLEARANCE:

Terms of the Generic ICR remain in effect.

OMB Authorizing Official:

Dominic J. Mancini
Deputy and Acting Administrator,
Office Of Information And Regulatory Affairs

IC Title

Form No.

White House Hotline
Call Center
Email/Survey
Veterans Experience
Agency Priority Goal
(APG) Trust Phone
Survey
Network Consolidated 10-0516
Laboratory (NCL)
Phlebotomy Service:
Patient Satisfaction
Questionnaire
Health Advocate Pilot
Project Patient
Satisfaction
Assessment
VISN 1 - Medical Center
Solutions Call Centers
Customer Satisfaction
Survey
VA Pittsburgh
Community Nursing
Home Satisfaction
Survey
Revised VE Outpatient
Survey
SORCC - Veterans
Satisfaction Survey of
Spiritual Care Needs
VEO Disability
Compensation Survey /
VE Outpatient Survey
Questions Non-Sub
Change Request
Veterans Benefits
Administration Veterans
Success on Campus
(VSOC) Survey
VHA Childcare Services 10-0531
Satisfaction Survey
Health Resource Center
(HRC) Satisfaction
Survey
Veterans Experience:
NCA Automated Phone
Survey
Income Verification
Survey
Community Residential
Care (CRC) Program
Veteran Survey
Medical Foster Home
(MFH) Program
Caregiver Survey
Medical Foster Home
(MFH) Program Veteran
Survey
Hydration Satisfaction
of Hines VA CLC
Residents
Home Health Care
Services Satisfaction
Questionnaire
MyVA Access Veteran
Interviews

List of ICs
Form Name

CFR Citation

Hrs/$/Resp
67 / 0 / 4,000
250 / 0 / 1,500

Patient Satisfaction
Questionnaire: Network
Consolidated Laboratory
(NCL) Phlebotomy
Service

431 / 0 / 8,612

13 / 0 / 150

287 / 0 / 4,300

10 / 0 / 120

33 / 0 / 200
7 / 0 / 200
538 / 0 / 32,300

3,333 / 0 / 20,000

Childcare Services
Satisfaction Survey

17 / 0 / 1,000
1,750 / 0 / 35,000
180 / 0 / 3,600
250 / 0 / 2,500
267 / 0 / 3,200
58 / 0 / 700
83 / 0 / 1,000
4 / 0 / 60
10 / 0 / 120
38 / 0 / 50

IC Title

Form No.

List of ICs
Form Name

CFR Citation

Purchased Care Patient 10-0583
Purchased Care Patient
Satisfaction Online
Satisfaction Online Survey
Survey
Spinal Cord Injury
10-0542
Spinal Cord Injury – Home
Home Care Patient
Care Patient Satisfaction
Satisfaction Survey
Survey
VISN 1 Call Centers
Customer Satisfaction
Survey
Michael DeBakey
10-0476
Michael E. Debakey
Satisfation Survey
Home Care Program
1_Spinal Cord Injury
10-0515
Spinal Cord Injury Patient
Survey__2_Non-Sub
Care Survey
Change-Veterans
Experience Access (VE
Outpatient Survey)
Scheduling
Appointment
VCS Customer
Satisfaction Focus
Groups
VISN 12 Telephone
10-10058
Telephone Care Services
Care Services
Patient Satisfaction
Satisfaction Survey
Survey
Veterans Experience
Feedback Tool: EComment Card
VISN 1 CLC Patient
Satisfaction Survey
State Veteran Home
Staff Interviews
VHA Women Veterans
Call Center Survey
VE: White House
Hotline VA Veterans
Call Center
Online/Phone Survey
Total Hours Actually Used for Information Collections Under Currently Approved ICR:

Hrs/$/Resp
960 / 0 / 4,800
5 / 0 / 30
287 / 0 / 4,300
18 / 0 / 100
13 / 0 / 80

93 / 0 / 280
33 / 0 / 200
11 / 0 / 135
1,075 / 0 / 6,450
40 / 0 / 40
8,667 / 0 / 130,000
279 / 0 / 16,720

19,107