VA Community Care Provider Satisfaction Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA, VBA, VHA)

⚠️ Notice: This information collection may be referencing outdated material.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
VACC Provider Satisfaction Survey Instrument 20180102.docx To be determined Other-Satisfaction Survey
VACC Provider Satisfaction Survey ICR 20180102.docx Generic Request - VACC IC Document
Survey Invitation.docx Survey Invitation IC Document
Survey Reminder Letter.docx Survey Reminder Letter IC Document

Information Collection (IC) Details

IC Title:	VA Community Care Provider Satisfaction Survey	Agency IC Tracking Number:	2900-0770

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-Satisfaction Survey			VACC Provider Satisfaction Survey Instrument 20180102.docx	To be determined	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	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	2,000	2,000
Annual IC Time Burden (Hours)	333	333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Request - VACC	VACC Provider Satisfaction Survey ICR 20180102.docx	04/12/2018
Survey Invitation	Survey Invitation.docx	04/12/2018
Survey Reminder Letter	Survey Reminder Letter.docx	04/12/2018

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