Information Collection

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

IC 234759 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⚠️ Notice: This information collection may be referencing outdated material.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
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.