Information Collection

VISN 1 CLC Patient Satisfaction Survey

IC 230323 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⚠️ Notice: This information collection may be referencing outdated material.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
VISN 1 CLC Survey with PRA Cover Letter.pdf	Other-Questionnaire
VISN 1 CLC Generic Clearance Submission.docx Generic Request - VISN 1 CLC Survey	IC Document
Sample Interview Training.pptx Sample Interview Training	IC Document

IC Title:

VISN 1 CLC Patient 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
Other-Questionnaire			VISN 1 CLC Survey with PRA Cover Letter.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 6,450

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	6,450	6,450
Annual IC Time Burden (Hours)	1,075	1,075
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Request - VISN 1 CLC Survey	VISN 1 CLC Generic Clearance Submission.docx	03/15/2018
Sample Interview Training	Sample Interview Training.pptx	03/01/2018

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