Information Collection Request

Clearance for A-11 Section 280 Improving Customer Experience Information Collection

ICR 202003-2900-011 · OMB 2900-0876 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 2900-0876-AD1 Enterprise Contact Center Council Debt Management Center Survey Form and Instruction New Available
Form 2900-0876-AC1 Office of Resolution Management, Diversity & Inclusion (ORMDI) Brand Health Survey Form and Instruction New Available
Form 2900-0876-AB1 Financial Services Center Vendor Support Survey Form and Instruction New Available
Form 2900-0876-AA2-1 COVID-19 Vaccine Survey Form and Instruction New Available
Form 2900-0875-AA1 Enterprise Contact Center Council Community Care (ECCC CC) Survey Form and Instruction New Available
Form 2900-0876-Z1 Enterprise Contact Center Council Veterans Experience Office (ECCC VEO) Form and Instruction New Available
Form 2900-0876-AB1 Telemedicine Form and Instruction New Available
Form 2900-0876-Y1 Board of Veterans Appeals Surveys Form and Instruction New Available
Form 2900-0876-V1 Outpatient Services Surveys Form and Instruction New Available
Form 2900-0876-Q3A Member Services Contact Center Survey Form and Instruction New Available
Form 2900-0876-R2 MAPPING THE CROSS-AGENCY CUSTOMER EXPERIENCE JOURNEY Form and Instruction New Available
Form 2900-08767-S1 Same Day Services Survey Form and Instruction New Repair queued
Form 2900-0876-Q2 VA.gov A-11 Survey Form and Instruction New Available
Form 2020-2900-0876-T2 Community Care Customer Experience Survey Form and Instruction New Available
Form 2020-2900-0876-S1 VBA Contact Center Survey Form and Instruction New Available
Form 2020-2900-0876-R1 Clinical Contact Center Survey Form and Instruction New Repair queued
Form 2900-0876-07A Covid-19 Veteran Customer Satisfaction Survey Form New Repair queued
Form 2900-0876-2020-5 Education Services Survey Form New Available
Form 2900-0876-003 No Show Survey Form and Instruction New Available
Form 2900-0876-002 Emergency Medicine Customer Satisfaction Survey Form and Instruction New Available
Form AMO001 Appeals Management Office Survey Form and Instruction New Available
A-11 60-Day FRN.docx Supplementary Document Uploaded 2020-03-13 Available
A-11 30-day FRN.docx Supplementary Document Uploaded 2020-03-13 Available
A-11 Fast-Track Clearance Request Template.docx Supplementary Document Uploaded 2020-03-13 Available
Supporting Statement B for Agencies_A 11 Section 280 Improving Customer Experience.docx Supporting Statement B Uploaded 2020-03-13 Available
Supporting Statement A for Agencies A_11 Section 280 Improving Customer Experience.docx Supporting Statement A Uploaded 2020-03-13 Available

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
245082 Enterprise Contact Center Council Debt Management Center Survey Form and Instruction New
245081 Office of Resolution Management, Diversity & Inclusion (ORMDI) Brand Health Survey Form and Instruction New
244706 Financial Services Center Vendor Support Survey Form and Instruction New
244374 COVID-19 Vaccine Survey Form and Instruction New
244301 Enterprise Contact Center Council Community Care (ECCC CC) Survey Form and Instruction New
243675 Enterprise Contact Center Council Veterans Experience Office (ECCC VEO) Form and Instruction New
243626 Telemedicine Form and Instruction New
243344 Board of Veterans Appeals Surveys Form and Instruction New
243253 Outpatient Services Surveys Form and Instruction New
243140 Member Services Contact Center Survey Form and Instruction New
243026 MAPPING THE CROSS-AGENCY CUSTOMER EXPERIENCE JOURNEY Form and Instruction New
242973 Same Day Services Survey Form and Instruction New
242822 VA.gov A-11 Survey Form and Instruction New
242500 Community Care Customer Experience Survey Form and Instruction New
242487 VBA Contact Center Survey Form and Instruction New
242473 Clinical Contact Center Survey Form and Instruction New
242272 Covid-19 Veteran Customer Satisfaction Survey Form New
242181 Education Services Survey Form New
241855 No Show Survey Form and Instruction New
241506 Emergency Medicine Customer Satisfaction Survey Form and Instruction New
241142 Appeals Management Office Survey Form and Instruction New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2023 36 Months From Approved
2,500,000 0 0
625,000 0 0
0 0 0





Reginfo record details
21
table that charts list of burden
IC Title Form No. Form Name
No Show Survey 2900-0876-003, 2900-0876-004 No Show Survey Questions Established Patients ,   No Show Survey Questions New Patients
Enterprise Contact Center Council Veterans Experience Office (ECCC VEO) 2900-0876-Z1, 2900-0876-Z2 ECCC_VEO Tier 1 Post Call Survey ,   ECCC_VEO White House Hotline Post Call Survey
Clinical Contact Center Survey 2020-2900-0876-R1 Clinical Contact Center Survey
Outpatient Services Surveys 2900-0876-V3, 2900-0876-V1, 2900-0876-V4, 2900-0876-V5, 2900-0876-V2 Outpatient Healthcare Visit ,   Pharmacy by Mail ,   Pharmacy in Person ,   Labs and Imaging ,   Scheduling an Appointment
Member Services Contact Center Survey 2900-0876-Q3A Member Services Contact Center Survey Wireframe
MAPPING THE CROSS-AGENCY CUSTOMER EXPERIENCE JOURNEY 2900-0876-R2 Cross Agency Field Guide
Emergency Medicine Customer Satisfaction Survey 2900-0876-002 Emergency Medicine Customer Satisfaction Survey
Appeals Management Office Survey AMO001 AMO Survey Wireframe
Education Services Survey 2900-0876-2020-5 Education Services Survey Wireframe
Financial Services Center Vendor Support Survey 2900-0876-AB1 Financial Services Center Vendor Support Survey Wireframe
VBA Contact Center Survey 2020-2900-0876-S1 VBA Contact Center Survey
Enterprise Contact Center Council Community Care (ECCC CC) Survey 2900-0875-AA1 ECCC Community Care Survey
VA.gov A-11 Survey 2900-0876-Q2 VA.Gov A-11 Survey Questions
Enterprise Contact Center Council Debt Management Center Survey 2900-0876-AD1 ECCC DMC Survey
Community Care Customer Experience Survey 2020-2900-0876-T2 Community Care Survey Wireframes
Board of Veterans Appeals Surveys 2900-0876-Y2, 2900-0876-Y1, 2900-0876-Y3, 2900-0876-Y4 Board Appeal Survey ,   Board Decision Survey ,   Board Hearing Survey ,   Board Notice of Disagreement (NOD) Survey
Same Day Services Survey 2900-08767-S1 Same Day Services Survey Questions
Office of Resolution Management, Diversity & Inclusion (ORMDI) Brand Health Survey 2900-0876-AC1 ORMDI Brand Health Survey
Telemedicine 2900-0876-AB1, 2900-AB3, 2900-0876-AB2, 2900-0876-AB4, 2900-0876-AB5, 2900-0876-AB6 Telemedicine Home Continuing Patient ,   Telemedicine Appointment Scheduling ,   Telemedicine At Home or Mobile Appointment ,   Telemedicine Clinic Appointment ,   Telemedicine Store Forward At Home or Mobile Appointment ,   Telemedicine Store Forward Results
COVID-19 Vaccine Survey 2900-0876-AA2-1, 2900-0876-AA2-2, 2900-0876-AA2-3, 2900-0876-AA2-4 COVID-19 Vaccine Trial VA interaction ,   COVID-19 Vaccine Trial Appointment ,   COVID-19 Vaccine Trial Study Team ,   COVID-19 Vaccine Trial VA.Gov
Covid-19 Veteran Customer Satisfaction Survey 2900-0876-07B, 2900-0876-07C, 2900-0876-07A Covid-19 Telehealth Survey ,   Covid-19 Post-Visit Survey ,   Covid-19 General Survey

table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,500,000 0 0 2,500,000 0 0
Annual Time Burden (Hours) 625,000 0 0 625,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No