Information Collection

VA Community Care Provider Satisfaction Survey

IC 230956 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⚠️ Notice: This information collection may be referencing outdated material.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
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.