Survey of Veterans' Satisfaction with the VA Dental Insurance Program (VADIP)

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⚠️ Notice: This information collection may be referencing outdated material.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
Form 10-211011 Survey of Veterans' Satisfaction with the VA Dental Insurance Program (VADIP) Form and Instruction
10-211011 Department of Veterans Affairs Dental Insurance Program VA Form 10-211011_Dental Insurance Program Survey_VADIP.pdf Form and Instruction
10-211011 Final Dental Survey Dental_Survey_Complete_May_2019.pdf Form and Instruction
Generic_Submission_Dental Insurance Surveyv2.docx Generic Submission Request_Dental Insurance Program Survey IC Document
Generic Cover w_seal_VADIP Survey_Jan 2019.docx Generic Cover w Seal_VADIP Survey IC Document

Information Collection (IC) Details

IC Title:	Survey of Veterans' Satisfaction with the VA Dental Insurance Program (VADIP)	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
Form and Instruction	10-211011	Final Dental Survey	Dental_Survey_Complete_May_2019.pdf		Yes	Yes	Fillable Printable
Form and Instruction	10-211011	Department of Veterans Affairs Dental Insurance Program Survey	VA Form 10-211011_Dental Insurance Program Survey_VADIP.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,120	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,180	3,180
Annual IC Time Burden (Hours)	795	795
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Submission Request_Dental Insurance Program Survey	Generic_Submission_Dental Insurance Surveyv2.docx	01/28/2019
Generic Cover w Seal_VADIP Survey	Generic Cover w_seal_VADIP Survey_Jan 2019.docx	02/06/2019

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