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

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0770 can be found here:

Documents and Forms

Document Name Document Type
Form 10-0516 Network Consolidated Laboratory (NCL) Phlebotomy Service: Patient Satisfaction Questionnaire Form
10-0516 Patient Satisfaction Questionnaire: Network Consolidated NCL Patient Satisfaction Questionnaire (final submission to OMB with cover page duplicate paperwork reduction act verbiage 8-7-1 Form
Generic FastTrack Request_ ConsolidLabPhlebotomy.docx Generic Request_NCL IC Document

Information Collection (IC) Details

IC Title:	Network Consolidated Laboratory (NCL) Phlebotomy Service: Patient Satisfaction Questionnaire	Agency IC Tracking Number:	2900-0770

IC Status: New

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	10-0516	Patient Satisfaction Questionnaire: Network Consolidated Laboratory (NCL) Phlebotomy Service	NCL Patient Satisfaction Questionnaire (final submission to OMB with cover page duplicate paperwork reduction act verbiage 8-7-17).docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,612	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,612	8,612
Annual IC Time Burden (Hours)	431	431
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Request_NCL	Generic FastTrack Request_ ConsolidLabPhlebotomy.docx	10/19/2017

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