Information Collection

Revised VE Outpatient Survey

IC 228703 under ICR 201710-2900-001 · OMB 2900-0770.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
2900-0770 VE OutpatSrveyRatingScaleMeasure08032017.pdf	Other-E-Survey
WhitePaper_Non-Sub Change-VE Outpatient Survey Questions.docx WhitePaper_Non-Sub Change-VE Outpatient Survey	IC Document
2900-0770 Justification_VE OutPat Appointment Scheduling SurveyJUN2017.docx 2900-0770 Justification_VE OutPat Appointment Scheduling Survey	IC Document

IC Title:

Revised VE Outpatient Survey

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-E-Survey			2900-0770 VE OutpatSrveyRatingScaleMeasure08032017.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
WhitePaper_Non-Sub Change-VE Outpatient Survey	WhitePaper_Non-Sub Change-VE Outpatient Survey Questions.docx	10/24/2017
2900-0770 Justification_VE OutPat Appointment Scheduling Survey	2900-0770 Justification_VE OutPat Appointment Scheduling SurveyJUN2017.docx	10/24/2017

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