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

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⚠️ Notice: This information collection may be referencing outdated material.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

Information Collection (IC) Details

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:

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 %

	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

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.