Information Collection

VetExperOffice_Telehealth Services Survey

IC 231800 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Telehealth_Survey Copy Deck_052118_V2.docx Web-based or other forms of Social Media Other-Customer Satisfaction Survey
Telehealth_GenericClearanceRqst_05.21.18.docx Telehealth Services VEO Survey IC Document
Telehealth Sample Design 042718.docx Telehealth Sample Design IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	VetExperOffice_Telehealth Services Survey	Agency IC Tracking Number:

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-Customer Satisfaction Survey			Telehealth_Survey Copy Deck_052118_V2.docx	Web-based or other forms of Social Media	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 60,000	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	60,000	60,000
Annual IC Time Burden (Hours)	2,000	2,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Telehealth Services VEO Survey	Telehealth_GenericClearanceRqst_05.21.18.docx	06/13/2018
Telehealth Sample Design	Telehealth Sample Design 042718.docx	06/13/2018

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