Information Collection

VA Loma Linda Healthcare System CBOC Clinics - Patient Satisfaction Survey

IC 237471 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⚠️ Notice: This information collection may be referencing outdated material.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
Loma Linda HC Sys CBOC Clinics_Patient Satis Survey_2019.docx	Other-Survey
Loma Linda HC System_CBOC Clinics_Patient Satis Survey_OMB passback revisions_01282020.docx	Other-Survey
Generic Supp Statement_Loma Linda CBOC Clinics_Patient Satis Survey_revised Oct 2019.doc Generic Supp Stmnt - Loma Linda CBOC Clinics Patient Satis Survey - 2019	IC Document
Generic Supp Statement_Loma Linda CBOC Clinics_Patient Satis Survey_OMB passback revisions_Jan 2020.docx Generic Supporting Statement - Revised	IC Document

IC Title:

VA Loma Linda Healthcare System CBOC Clinics - Patient Satisfaction Survey

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
Other-Survey			Loma Linda HC Sys CBOC Clinics_Patient Satis Survey_2019.docx		No		Paper Only
Other-Survey			Loma Linda HC System_CBOC Clinics_Patient Satis Survey_OMB passback revisions_01282020.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,200

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	1,200	1,200
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Supp Stmnt - Loma Linda CBOC Clinics Patient Satis Survey - 2019	Generic Supp Statement_Loma Linda CBOC Clinics_Patient Satis Survey_revised Oct 2019.doc	11/20/2019
Generic Supporting Statement - Revised	Generic Supp Statement_Loma Linda CBOC Clinics_Patient Satis Survey_OMB passback revisions_Jan 2020.docx	01/28/2020

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