Information Collection

VA Community Care Network Provider Satisfaction Survey for Regions 1, 2, 3 and 4

IC 232311 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⚠️ Notice: This information collection may be referencing outdated material.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
CCN Provider Survey Region 1 2018 June 27 v2.docx	Other-Survey
CCN Provider Survey Region 2 2018 June 27 v2.docx	Other-Survey
CCN Provider Survey Region 3 2018 June 27 v2.docx	Other-Survey
CCN Provider Survey Region 4 2018 June 27 v2.docx	Other-Survey
CCN Provider Survey ICR_080118.doc Generic Request - CCN Provider Survey	IC Document
Survey Invitation.docx CCN Survey Invitation	IC Document
Survey Reminder Letter.docx CCN Survey Reminder Letter	IC Document

IC Title:

VA Community Care Network Provider Satisfaction Survey for Regions 1, 2, 3 and 4

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	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey	CCN Provider Survey Region 1 2018 June 27 v2.docx	TBD	Yes	Yes	Fillable Fileable
Other-Survey	CCN Provider Survey Region 2 2018 June 27 v2.docx	TBD	Yes	Yes	Fillable Fileable
Other-Survey	CCN Provider Survey Region 3 2018 June 27 v2.docx	TBD	Yes	Yes	Fillable Fileable
Other-Survey	CCN Provider Survey Region 4 2018 June 27 v2.docx	TBD	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 8,000

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	8,000	8,000
Annual IC Time Burden (Hours)	1,333	1,333
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Request - CCN Provider Survey	CCN Provider Survey ICR_080118.doc	08/01/2018
CCN Survey Invitation	Survey Invitation.docx	08/01/2018
CCN Survey Reminder Letter	Survey Reminder Letter.docx	08/01/2018

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