Information Collection

VHA Veteran Inpatient Services VEO Survey / VBA Contact Center

IC 233695 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⚠️ Notice: This information collection may be referencing outdated material.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
Inpatient_SurveyMockup_103118_v4.pdf	Other-eSurvey
VBACC_SurveyMockup_10.31.18_V1.2.pdf	Other-eSurvey
Inpatient_FastTrackClearance_10.23.18.docx VHA Veteran Inpatient Services VEO Survey	IC Document
VBACC_FastTrackClearance_10.30.18.docx VBA Contact Center	IC Document
Inpatient Sampling Plan_102318.docx Inpatient Sampling	IC Document
VBA CC Sampling Plan_10.30.18.docx VBA Contact Center Sampling Plan	IC Document
Inpatient_EmailsMockup_102518_v4.pdf Inpatient Email Mock Up	IC Document
VBACC_EmailMockup_10.31.18_V1.2.pdf VBA Contact Center Email Mock-Up	IC Document

IC Title:

VHA Veteran Inpatient Services VEO Survey / VBA Contact Center

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-eSurvey			Inpatient_SurveyMockup_103118_v4.pdf	TBD	Yes	Yes	Fillable Fileable
Other-eSurvey			VBACC_SurveyMockup_10.31.18_V1.2.pdf	TBD	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 236,112

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	236,112	236,112
Annual IC Time Burden (Hours)	7,870	7,870
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
VHA Veteran Inpatient Services VEO Survey	Inpatient_FastTrackClearance_10.23.18.docx	11/01/2018
VBA Contact Center	VBACC_FastTrackClearance_10.30.18.docx	11/01/2018
Inpatient Sampling	Inpatient Sampling Plan_102318.docx	11/01/2018
VBA Contact Center Sampling Plan	VBA CC Sampling Plan_10.30.18.docx	11/01/2018
Inpatient Email Mock Up	Inpatient_EmailsMockup_102518_v4.pdf	11/01/2018
VBA Contact Center Email Mock-Up	VBACC_EmailMockup_10.31.18_V1.2.pdf	11/01/2018

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