Information Collection

1_Spinal Cord Injury Survey__2_Non-Sub Change-Veterans Experience Access (VE Outpatient Survey) Scheduling Appointment

IC 230108 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⚠️ Notice: This information collection may be referencing outdated material.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
Form 10-0515 Spinal Cord Injury Patient Care Survey 1_Spinal Cord Injury Survey__2_Non-Sub Change-Veterans Experience Access (VE Outpatient Survey) Scheduling Appointment	Form and Instruction
VEOutpatientSurvey_OMB02.26.18.pdf	Other-E-Survey
10-0515 Spinal Cord Injury Patient Care Survey Spinal Cord Injury Patient Care Survey.doc	Form and Instruction
Generic Clearance_Spinal Cord Injury.doc Generic Request_Spinal Cord Injury	IC Document
White Paper_NonSubChange OutpatientSrvy_02.20.18.docx White Paper_NonSubChange VE Outpatient Survey	IC Document
2017 NOA for VEOutpatient Generic 2900-0770.pdf 2017 NOA for VE Outpatient Generic 2900-0770 Clearance	IC Document
Justification_VE OutPat Appointment Scheduling SurveyJUN2017.docx Justification_VE OutPat Appointment Scheduling SurveyJUN2017	IC Document

IC Title:

1_Spinal Cord Injury Survey__2_Non-Sub Change-Veterans Experience Access (VE Outpatient Survey) Scheduling Appointment

Agency IC Tracking Number:

2900-0770

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
Form and Instruction	10-0515	Spinal Cord Injury Patient Care Survey	Spinal Cord Injury Patient Care Survey.doc		No		Paper Only
Other-E-Survey			VEOutpatientSurvey_OMB02.26.18.pdf	â¢Appointments - https://survey.voice.medallia.com/?va-trx-apt â¢Healthcare - https://survey.voice.medallia.com/?va-trx-healthcare â¢Labs - https://survey.voice.medallia.com/?va-trx-lab â¢Pharmacy - https://survey.voice.medallia.com/?va-trx-pharmacy â¢Pharmacy Mail - https://survey.voice.medallia.com/?va-trx-pharmacy-mail	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 80

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	80	80
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Request_Spinal Cord Injury	Generic Clearance_Spinal Cord Injury.doc	02/14/2018
White Paper_NonSubChange VE Outpatient Survey	White Paper_NonSubChange OutpatientSrvy_02.20.18.docx	03/05/2018
2017 NOA for VE Outpatient Generic 2900-0770 Clearance	2017 NOA for VEOutpatient Generic 2900-0770.pdf	03/05/2018
Justification_VE OutPat Appointment Scheduling SurveyJUN2017	Justification_VE OutPat Appointment Scheduling SurveyJUN2017.docx	03/05/2018

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