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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

IC Title:

VetExperOffice_Telehealth Services Survey

Agency IC Tracking Number:

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-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 %

table that charts list of burden
	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

table that charts IC Documents
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.