Information Collection

Understanding Patient Perceptions of Access in VISN 22

IC 230273 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⚠️ Notice: This information collection may be referencing outdated material.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
Patient_Perceptions_of_Access_Interview_Guide_clean_ 1.10.18 le.docx	Other-Interview Questions
VA Generic Fast-Track Clearance Request_Stockdale_clean_1.17.18 le.docx Generic Request_VISN 22 Patient Perceptions	IC Document
VAIL_2.0 QI memo for patient focus group_3_20_17_Dresselhaus.pdf Memo	IC Document
Interview_Invitation_Letter_final_clean_ 1.10.18 le.docx Invitation Letter	IC Document
Question and Answer Addendum_Stockdale_clean_1.10.18_le.docx Q&A	IC Document

IC Title:

Understanding Patient Perceptions of Access in VISN 22

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
Other-Interview Questions			Patient_Perceptions_of_Access_Interview_Guide_clean_ 1.10.18 le.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

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	50	50
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Request_VISN 22 Patient Perceptions	VA Generic Fast-Track Clearance Request_Stockdale_clean_1.17.18 le.docx	03/29/2018
Memo	VAIL_2.0 QI memo for patient focus group_3_20_17_Dresselhaus.pdf	02/27/2018
Invitation Letter	Interview_Invitation_Letter_final_clean_ 1.10.18 le.docx	02/27/2018
Q&A	Question and Answer Addendum_Stockdale_clean_1.10.18_le.docx	02/27/2018

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