MACC Request for Approval

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 2900-0770)

TITLE OF INFORMATION COLLECTION:

MISSION Act Comment Card

PURPOSE: The survey will gauge respondents’ perceptions on the accessibility of information in regards to the VA MISSION Act. The goal of this qualitative study is to provide immediate information to VHA stakeholders about the efficacy of VHA communicating information concerning the MISSION Act and the potential volume of veterans receiveing health care through the MISSION Act. This data will be used to improve services and communications around the MISSION Act.

DESCRIPTION OF RESPONDENTS:

• Any veteran who has mentioned the MISSION Act or a MISSION Act-related topic on the VEO Outpatient survey.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [X] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [] Other: ______________________

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name:
Anil Tilbe
[email protected]

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [X] No

2. If Yes, will any information that is collected be included in records that are subject to the Privacy Act of 1974? [ ] Yes [ ] No

3. If Yes, has an up-to-date System of Records Notice (SORN) been published? [ ] Yes [ ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [X] No

BURDEN HOURS

Category of Respondent	No. of Respondents	Participation Time	Burden
Individuals	12,000 Annual	2 minutes	400 hours
Totals	12,000 Annual	2 minutes	400 hours

FEDERAL COST: The estimated annual cost to the Federal government is $0. The comment card was modified from the Community Engagement Digital Comment Card that was approved by OMB and implemented into the VSignals survey delivery system. Furthermore, the data collection and analysis will be conducted by existing contractors as part of their contractual obligations. Because the survey infrastructure had previously been developed, there are no additional costs to the government to design and carry out this data collection beyond normal labor costs.

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [X] Yes [] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

The list of targeted respondents are respondents to the VEO Outpatient survey that reported the MISSION Act or a MISSION Act-related topic in an open-ended survey question on the survey in the week occurring two weeks after the close of data collection for that Outparient survey round. This list represents the most up-to-date list because of the recent passage of the MISSION Act. We do not have any other data that can identify targeted respondents for this survey. Approximately 550 Outpatient respondents report either of these items in a two-week period and all 550 will be selected for the MISSION Act Comment Card. We will select an additional 550 Outpatient survey respondents who did not report any MISSION Act-related topics in the open-ended suvey question for a total sample of approximately 1,100 targeted respondents. Because of the risk of selection bias in the final estimates, this list is not intended to be representative of the targeted population, nor will VEO attempt to apply any adjustment to make the final respondent represent any sort of population. Sampling of these targeted respondents will occur each Friday. The targeted respondents will receive an email invitation with an embedded hyperlink to the MISSION Act Comment Card in the VSignals survey reporting tool. The targteted respondents will have two weeks to respond and will receive a reminder email if they have not responded in one week after recruitment. The expected response rate is 20%, which has been seen in other VEO Internet surveys that utilize a one-week email reminder. The unadjusted estimates will be shown through the VSignals survey reporting tool to analysts and stakeholders within the VA for service improvement.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[X] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[X] Other, Explain E-mail invitation

2. Will interviewers or facilitators be used? [ ] Yes [X] No

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