VHA Outpatient Customer Satisfaction Survey

American Customer Satisfaction Index "Customer Satisfaction Surveys"

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0007 can be found here:

Documents and Forms

Document Name Document Type
Form 038 VHA Outpatient Customer Satisfaction Survey Form and Instruction
038 VHA Outpatient Customer Satisfaction Survey VHA_Outpatient 2018 Survey Final.docx Form and Instruction
Generic Clearance Request Form_VA Outpatient IA 20805 A0.pdf Generic Clearance Request Form IC Document
OMB Mapping Cover VA Outpatient IA 20805 A0 .xlsx Mapping Cover VHA Outpatient IC Document

Information Collection (IC) Details

IC Title:	VHA Outpatient Customer Satisfaction Survey	Agency IC Tracking Number:	038

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
Form and Instruction	038	VHA Outpatient Customer Satisfaction Survey	VHA_Outpatient 2018 Survey Final.docx		Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Clearance Request Form	Generic Clearance Request Form_VA Outpatient IA 20805 A0.pdf	10/11/2018
Mapping Cover VHA Outpatient	OMB Mapping Cover VA Outpatient IA 20805 A0 .xlsx	10/11/2018

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