Information Collection

1. VISN 1 Outpatient Mental Health Patient Satisfaction Survey / 2. VE NCA Survey_Non-Sub Change

IC 231418 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⚠️ Notice: This information collection may be referencing outdated material.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 MH Survey with PRA Cover Letter.pdf To be determined	Other-Satisfaction Survey
NCA Survey 05172018.docx Automated Phone Survey	Other-Phone Survey
VISN 1 MH Generic Clearance Submission_050818.doc Generic Request_VISN 1 Mental Health	IC Document
White Paper_NCA_Survey NonSubChange_05.17.18.docx White Paper NCA_Survey NonSubChange_	IC Document
2900-0770 NCA Survey Approval Notice.pdf 2900-0770 NCA Survey Approval Notice	IC Document
NCA Copy Deck_5.04.18.docx NCA Copy Deck	IC Document
Generic Clearance Request_VE NCA Phone Survey_11082017.docx Generic Clearance Request_VE NCA Phone Survey_11082017	IC Document

IC Title:

1. VISN 1 Outpatient Mental Health Patient Satisfaction Survey / 2. VE NCA Survey_Non-Sub Change

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			VISN 1 MH Survey with PRA Cover Letter.pdf	To be determined	Yes	Yes	Fillable Printable
Other-Phone Survey			NCA Survey 05172018.docx	Automated Phone Survey	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13,200

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	13,200	13,200
Annual IC Time Burden (Hours)	2,200	2,200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Request_VISN 1 Mental Health	VISN 1 MH Generic Clearance Submission_050818.doc	05/10/2018
White Paper NCA_Survey NonSubChange_	White Paper_NCA_Survey NonSubChange_05.17.18.docx	05/17/2018
2900-0770 NCA Survey Approval Notice	2900-0770 NCA Survey Approval Notice.pdf	05/17/2018
NCA Copy Deck	NCA Copy Deck_5.04.18.docx	05/17/2018
Generic Clearance Request_VE NCA Phone Survey_11082017	Generic Clearance Request_VE NCA Phone Survey_11082017.docx	05/17/2018

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