Information Collection

Whole Health Patient Satisfaction Survey

IC 239637 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Whole Health Patient Satisfaction Survey_revisions June 2020.docx Other-survey
Generic Supp Statement_Whole Health Patient Satis Survey_revised June 2020.docx Whole Health Patient Satisfaction Survey - Generic Supp Statement IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Whole Health Patient Satisfaction Survey	Agency IC Tracking Number:	VHA-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
Other-survey			Whole Health Patient Satisfaction Survey_revisions June 2020.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,400	2,400
Annual IC Time Burden (Hours)	200	200
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Whole Health Patient Satisfaction Survey - Generic Supp Statement	Generic Supp Statement_Whole Health Patient Satis Survey_revised June 2020.docx	07/29/2020

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