Information Collection

Veterans Experience Access Survey Questions Scheduling

IC 228529 under ICR 201710-2900-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
VEOutpatientSurvey_OMB02.26.18.pdf survey.voice.medallia.com/	Other-Survey
Outpatient Survey_Format-Non-Sub Revisions_102018 version.pdf survey.voice.medallia.com/	Other-Survey

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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			Outpatient Survey_Format-Non-Sub Revisions_102018 version.pdf	https://survey.voice.medallia.com/	Yes	Yes	Fillable Fileable
Other-Survey			VEOutpatientSurvey_OMB02.26.18.pdf	https://survey.voice.medallia.com/	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,800,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,800,000	1,800,000
Annual IC Time Burden (Hours)	30,000	30,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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