Survey Reporting - Veterans Experience Access Outpatient Survey Questions

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
NOA VE Outpt AccessSrvy Change 2900-0770.pdf	Supplementary Document	Uploaded 2018-09-24	Repair queued
30-Day FRN_VE Outpatient_Survey Reporting.pdf	Supplementary Document	Uploaded 2018-09-24	Repair queued
Justification B_Outpatient 09.24.2018 v2.docx	Supporting Statement B	Uploaded 2018-11-01	Repair queued
Justification A_Outpatient_09.24.18v2.docx	Supporting Statement A	Uploaded 2018-11-01	Repair queued
60-day FRN VE OutpatientSurveyReport.pdf	Supplementary Document	Uploaded 2018-09-24	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
228529	Veterans Experience Access Survey Questions Scheduling	Other-Survey	New

ICR Details

OMB Control No:	ICR Reference No: 201710-2900-002
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No:
Title: Survey Reporting - Veterans Experience Access Outpatient Survey Questions
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted	Conclusion Date: 08/21/2019
	Date Received in OIRA: 11/01/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: In response to Executive Order 12862, “Improving Customer Service through Effective Performance Management”, the Department of Veterans Affairs (VA) is conducting surveys to determine the level of satisfaction with existing services among their customers. The surveys solicit voluntary opinions and are not intended to collect information required to obtain or maintain eligibility for a VA program or benefit. This submission is a request by VA to the Office of Management and Budget (OMB) for the following approval: Grant VA clearance to publicly publish data previously collected under Generic clearance 2900-0770.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Improving Customer Service through Effective Performance Management
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 45362	09/28/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 3053	01/12/2018
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Veterans Experience Access Survey Questions Scheduling

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection request. All hours are considered a burden increase.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/01/2018

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