Form OAWP 001 OAWP 001 Office of Accountability and Whistleblower Protection Su

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA, VBA, VHA)

OAWP EX Wireframe_v24

Office of Accountability and Whistleblower Protection Survey

OMB: 2900-0770

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The VA provides free, confidential support 24/7 for Veterans and their family and friends. If you are in crisis, contact the Veterans Crisis Line by dialing 1 (800) 273-8255 (Press 1), or texting 838255, or visiting https://www.veteranscrisisline.net. If you are homeless or at risk of homelessness, contact the National Call Center for Homeless Veterans (NCCHV) by dialing 1 (877) 424-3838 or visiting https://www.va.gov/HOMELESS/.





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OMB Number: 2900-0770

Expiration: 09/30/2020 Estimated Burden: 2 minutes









Help us serve you better

We want to hear about your experience with the Office of Accountability and Whistleblower Protection (OAWP)



1. Please provide feedback with a concern, compliment, or recommendation about your experience(s) with OAWP? Please select from one of the following options. 

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Options are (1) compliment, (2) concern, (3) recommendation




2. Please use the text box below to enter details of the feedback. Please do not include your personally identifiable information, such as Social Security Number, Veteran ID, or medical information, but do provide details about your experience.

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experience

experience

3. Can the Department of Veterans Affairs contact you about your feedback?



If you said yes, please voluntarily provide us with the following information:


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4. What is your first name?

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5. What is your last name?

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6. What is your email address?

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Shape15 We are asking for this information so that you can provide compliments, recommendations, or concerns to VA. This information is collected in accordance with section 3507 of the Paperwork Reduction Act of 1995. Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of two minutes to review the instructions and complete this survey. The results of this survey will be used to inform opportunities for program improvement in the quality of VA services. Participation in this survey is voluntary, and your decision not to respond will have no impact on VA benefits or services to which you may currently be receiving. By filling out this survey, you are authorizing VA database access to retrieve veteran contact information to follow up with you accordingly for purposes of service recovery, potential crisis, or to learn more about feedback you have shared regarding your experience with VA. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.reginfo.gov/public/do/PRAMain. Information gathered will be kept private to the extent provided by law.

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorPeters, Aaron M. (BAH)
File Modified0000-00-00
File Created2021-01-14

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