Information Collection

VISN 12 Telephone Care Services Satisfaction Survey

IC 230206 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⚠️ Notice: This information collection may be referencing outdated material.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 10-10058 VISN 12 Telephone Care Services Satisfaction Survey	Form and Instruction
10-10058 Telephone Care Services Patient Satisfaction Survey Telephone Care Service Survey 10-10058.docx	Form and Instruction
VA Generic_Clearance_Submission_VISN 12 Telephone Care Services Survey.docx Generic Request - VISN 12 Telephone Care	IC Document

IC Title:

VISN 12 Telephone Care Services Satisfaction Survey

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	10-10058	Telephone Care Services Patient Satisfaction Survey	Telephone Care Service Survey 10-10058.docx		No		Paper Only

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
Generic Request - VISN 12 Telephone Care	VA Generic_Clearance_Submission_VISN 12 Telephone Care Services Survey.docx	02/21/2018

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