Information Collection

Veterans Experience Feedback Tool: E-Comment Card

IC 230219 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
E-Comment Card_(Rev).pdf survey.voice.medallia.com/?vavoice-vftsurvey# Other-Web: E-Comment Card
VEFeedbackeComment_NonSubChange_02.15.18 (3).docx Non-Substantive Change Request White Paper IC Document
NOA VE Feedback Tool.pdf NOA VE Feedback 2017 IC Document
VE Feedback Tool - Generic Clearance Request (OMB 2900-0770)_03.15.2017.docx Generic Clearance Request (OMB 2900-0770)_03.15.2017 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Veterans Experience Feedback Tool: E-Comment Card	Agency IC Tracking Number:

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
Other-Web: E-Comment Card			E-Comment Card_(Rev).pdf	https://survey.voice.medallia.com/?vavoice-vftsurvey#	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 135	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	135	135
Annual IC Time Burden (Hours)	11	11
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Non-Substantive Change Request White Paper	VEFeedbackeComment_NonSubChange_02.15.18 (3).docx	02/22/2018
NOA VE Feedback 2017	NOA VE Feedback Tool.pdf	02/22/2018
Generic Clearance Request (OMB 2900-0770)_03.15.2017	VE Feedback Tool - Generic Clearance Request (OMB 2900-0770)_03.15.2017.docx	02/22/2018

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