Information Collection Request

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

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

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form No Show Imaging Su No Show Imaging Survey Form and Instruction New Repair queued
Form OPIA/VEO Customer OPIA/VEO Customer Survey Form and Instruction New Repair queued
Form Emergency Medicine Emergency Medicine Community Care survey wireframe Form and Instruction New Repair queued
Form 2900-0876-Veterans 2900-0876-Veterans Safety Survey Form and Instruction New Repair queued
Form 2900-0876-VEAC Sur 2900-0876-VEAC Survey Wireframe Form and Instruction New Repair queued
Form 2900-0876-GEC-surv 2900-0876-GEC-survey wireframes Form and Instruction New Repair queued
Form 2900-0876-RCS Surv 2900-0876-RCS Survey Wireframes Form and Instruction New Repair queued
Form 2900-0876-C2 Preferences for Care During Covid Survey Form and Instruction New Repair queued
Form 2900-0876-Covid va 2900-0876-Covid vaccine acceptance survey Form and Instruction New Repair queued
Form 2900-0876-COVID-19 COVID-19 Vaccine Veterans Ex- survey wireframe Form and Instruction New Repair queued
Form 2900-0876 - VHA In VHA Inpatient Survey wireframe Form and Instruction New Repair queued
Form 2900-0876-EMT-1 Emergency Medicine Telehealth Survey Wireframe Form and Instruction New Repair queued
Form 2900-0876-Transiti Transition Care and Management VA Liaison Survey Form and Instruction New Repair queued
Form 2900-0876-AA ECCC_NCA_Survey Form and Instruction New Repair queued
Form 2900-0876-AD1 ECCC DMC Survey Form and Instruction New Available
Form 2900-0876-AC1 ORMDI Brand Health Survey Form and Instruction New Available
Form 2900-0876-AB1 Financial Services Center Vendor Support Survey Wireframe Form and Instruction New Available
Form 2900-0876-AA2-4 COVID-19 Vaccine Trial VA.Gov Form and Instruction New Available
Form 2900-0876-AA2-3 COVID-19 Vaccine Trial Study Team Form and Instruction New Available
Form 2900-0876-AA2-2 COVID-19 Vaccine Trial Appointment Form and Instruction New Available
Form 2900-0876-AA2-1 COVID-19 Vaccine Trial VA interaction Form and Instruction New Available
Form 2900-0875-AA1 ECCC Community Care Survey Form and Instruction New Available
Form 2900-0876-Z2 ECCC_VEO White House Hotline Post Call Survey Form and Instruction New Available
Form 2900-0876-Z1 ECCC_VEO Tier 1 Post Call Survey Form and Instruction New Available
Form 2900-0876-AB6 Telemedicine Store Forward Results Form and Instruction New Available
Form 2900-0876-AB5 Telemedicine Store Forward At Home or Mobile Appointment Form and Instruction New Available
Form 2900-0876-AB4 Telemedicine Clinic Appointment Form and Instruction New Available
Form 2900-AB3 Telemedicine At Home or Mobile Appointment Form and Instruction New Available
Form 2900-0876-AB2 Telemedicine Appointment Scheduling Form and Instruction New Available
Form 2900-0876-AB1 Telemedicine Home Continuing Patient Form and Instruction New Available
Form 2900-0876-Y4 Board Notice of Disagreement (NOD) Survey Form and Instruction New Available
Form 2900-0876-Y3 Board Hearing Survey Form and Instruction New Repair queued
Form 2900-0876-Y2 Board Decision Survey Form and Instruction New Available
Form 2900-0876-Y1 Board Appeal Survey Form and Instruction New Available
Form 2900-0876-V2 Scheduling an Appointment Form and Instruction New Available
Form 2900-0876-V3 Labs and Imaging Form and Instruction New Available
Form 2900-0876-V5 Pharmacy in Person Form and Instruction New Available
Form 2900-0876-V4 Pharmacy by Mail Form and Instruction New Available
Form 2900-0876-V1 Outpatient Healthcare Visit Form and Instruction New Available
Form 2900-0876-Q3A Member Services Contact Center Survey Wireframe Form and Instruction New Available
Form 2900-0876-R2 Cross Agency Field Guide Form and Instruction New Available
Form 2900-08767-S1 Same Day Services Survey Questions Form and Instruction New Available
Form 2900-0876-Q2 VA.Gov A-11 Survey Questions Form and Instruction New Available
Form 2020-2900-0876-T2 Community Care Survey Wireframes 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 Available
Form 2900-0876-07C Covid-19 General Survey Form New Available
Form 2900-0876-07B Covid-19 Post-Visit Survey Form New Available
Form 2900-0876-07A Covid-19 Telehealth Survey Form New Repair queued
Form 2900-0876-2020-5 Education Services Survey Wireframe Form New Available
Form 2900-0876-004 No Show Survey Questions New Patients Form and Instruction New Available
Form 2900-0876-003 No Show Survey Questions Established Patients Form and Instruction New Available
Form 2900-0876-002 Emergency Medicine Customer Satisfaction Survey Form and Instruction New Available
Form AMO001 AMO Survey Wireframe 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
248642 No Show Imaging Survey Form and Instruction NewNo Show Imaging Survey
248615 OPIA/VEO Customer Survey Form and Instruction NewOPIA/VEO Customer Survey
248473 Emergency Medicine Community Care Survey Form and Instruction NewEmergency Medicine Community Care survey wireframe
248048 Veterans Safety Survey Form and Instruction New2900-0876-Veterans Safety Survey
248027 VEAC Survey Form and Instruction New2900-0876-VEAC Survey Wireframe
247924 Geriatrics Extended Care (GEC) Survey Form and Instruction New2900-0876-GEC-survey wireframes
247696 Readjustment Counseling Services (RCS) Vet Center Survey Form and Instruction New2900-0876-RCS Survey Wireframes
247125 Preferences for Care During Covid Survey Form and Instruction NewPreferences for Care During Covid Survey
247036 COVID-19 Vaccine Acceptance Form and Instruction New2900-0876-Covid vaccine acceptance survey
246951 COVID-19 Vaccine Veterans Experience Survey Form and Instruction NewCOVID-19 Vaccine Veterans Ex- survey wireframe
246875 VHA Inpatient Survey Form and Instruction NewVHA Inpatient Survey wireframe
246473 Emergency Medicine Telehealth Customer Satisfaction Survey Form and Instruction NewEmergency Medicine Telehealth Survey Wireframe
246027 Transition Care and Management VA Liaison Survey Form and Instruction NewTransition Care and Management VA Liaison Survey
245491 Enterprise Contact Center Council National Cemetery Administration (ECCC NCA) Survey Form and Instruction NewECCC_NCA_Survey
245082 Enterprise Contact Center Council Debt Management Center Survey Form and Instruction NewECCC DMC Survey
245081 Office of Resolution Management, Diversity & Inclusion (ORMDI) Brand Health Survey Form and Instruction NewORMDI Brand Health Survey
244706 Financial Services Center Vendor Support Survey Form and Instruction NewFinancial Services Center Vendor Support Survey Wireframe
244374 COVID-19 Vaccine Survey Form and Instruction NewCOVID-19 Vaccine Trial VA.Gov
244374 COVID-19 Vaccine Survey Form and Instruction NewCOVID-19 Vaccine Trial Study Team
244374 COVID-19 Vaccine Survey Form and Instruction NewCOVID-19 Vaccine Trial Appointment
244374 COVID-19 Vaccine Survey Form and Instruction NewCOVID-19 Vaccine Trial VA interaction
244301 Enterprise Contact Center Council Community Care (ECCC CC) Survey Form and Instruction NewECCC Community Care Survey
243675 Enterprise Contact Center Council Veterans Experience Office (ECCC VEO) Form and Instruction NewECCC_VEO White House Hotline Post Call Survey
243675 Enterprise Contact Center Council Veterans Experience Office (ECCC VEO) Form and Instruction NewECCC_VEO Tier 1 Post Call Survey
243626 Telemedicine Form and Instruction NewTelemedicine Store Forward Results
243626 Telemedicine Form and Instruction NewTelemedicine Store Forward At Home or Mobile Appointment
243626 Telemedicine Form and Instruction NewTelemedicine Clinic Appointment
243626 Telemedicine Form and Instruction NewTelemedicine At Home or Mobile Appointment
243626 Telemedicine Form and Instruction NewTelemedicine Appointment Scheduling
243626 Telemedicine Form and Instruction NewTelemedicine Home Continuing Patient
243344 Board of Veterans Appeals Surveys Form and Instruction NewBoard Notice of Disagreement (NOD) Survey
243344 Board of Veterans Appeals Surveys Form and Instruction NewBoard Hearing Survey
243344 Board of Veterans Appeals Surveys Form and Instruction NewBoard Decision Survey
243344 Board of Veterans Appeals Surveys Form and Instruction NewBoard Appeal Survey
243253 Outpatient Services Surveys Form and Instruction NewScheduling an Appointment
243253 Outpatient Services Surveys Form and Instruction NewLabs and Imaging
243253 Outpatient Services Surveys Form and Instruction NewPharmacy in Person
243253 Outpatient Services Surveys Form and Instruction NewPharmacy by Mail
243253 Outpatient Services Surveys Form and Instruction NewOutpatient Healthcare Visit
243140 Member Services Contact Center Survey Form and Instruction NewMember Services Contact Center Survey Wireframe
243026 MAPPING THE CROSS-AGENCY CUSTOMER EXPERIENCE JOURNEY Form and Instruction NewCross Agency Field Guide
242973 Same Day Services Survey Form and Instruction NewSame Day Services Survey Questions
242822 VA.gov A-11 Survey Form and Instruction NewVA.Gov A-11 Survey Questions
242500 Community Care Customer Experience Survey Form and Instruction NewCommunity Care Survey Wireframes
242487 VBA Contact Center Survey Form and Instruction NewVBA Contact Center Survey
242473 Clinical Contact Center Survey Form and Instruction NewClinical Contact Center Survey
242272 Covid-19 Veteran Customer Satisfaction Survey Form NewCovid-19 General Survey
242272 Covid-19 Veteran Customer Satisfaction Survey Form NewCovid-19 Post-Visit Survey
242272 Covid-19 Veteran Customer Satisfaction Survey Form NewCovid-19 Telehealth Survey
242181 Education Services Survey Form NewEducation Services Survey Wireframe
241855 No Show Survey Form and Instruction NewNo Show Survey Questions New Patients
241855 No Show Survey Form and Instruction NewNo Show Survey Questions Established Patients
241506 Emergency Medicine Customer Satisfaction Survey Form and Instruction NewEmergency Medicine Customer Satisfaction Survey
241142 Appeals Management Office Survey Form and Instruction NewAMO Survey Wireframe

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
35
table that charts list of burden
IC Title Form No. Form Name
Emergency Medicine Customer Satisfaction Survey 2900-0876-002
Appeals Management Office Survey AMO001
Board of Veterans Appeals Surveys 2900-0876-Y2, 2900-0876-Y1, 2900-0876-Y3, 2900-0876-Y4 ,   ,   ,  
COVID-19 Vaccine Acceptance 2900-0876-Covid vaccine acceptance survey
COVID-19 Vaccine Survey 2900-0876-AA2-1, 2900-0876-AA2-2, 2900-0876-AA2-3, 2900-0876-AA2-4 ,   ,   ,  
COVID-19 Vaccine Veterans Experience Survey 2900-0876-COVID-19 Vaccine Veterans Ex- survey
Clinical Contact Center Survey 2020-2900-0876-R1
Community Care Customer Experience Survey 2020-2900-0876-T2
Covid-19 Veteran Customer Satisfaction Survey 2900-0876-07B, 2900-0876-07C, 2900-0876-07A ,   ,  
Education Services Survey 2900-0876-2020-5
Emergency Medicine Community Care Survey Emergency Medicine Community Care survey wireframe
Emergency Medicine Telehealth Customer Satisfaction Survey 2900-0876-EMT-1
Enterprise Contact Center Council Community Care (ECCC CC) Survey 2900-0875-AA1
Enterprise Contact Center Council Debt Management Center Survey 2900-0876-AD1
Enterprise Contact Center Council National Cemetery Administration (ECCC NCA) Survey 2900-0876-AA
Enterprise Contact Center Council Veterans Experience Office (ECCC VEO) 2900-0876-Z1, 2900-0876-Z2 ,  
Financial Services Center Vendor Support Survey 2900-0876-AB1
Geriatrics Extended Care (GEC) Survey 2900-0876-GEC-survey wireframes
MAPPING THE CROSS-AGENCY CUSTOMER EXPERIENCE JOURNEY 2900-0876-R2
Member Services Contact Center Survey 2900-0876-Q3A
No Show Imaging Survey No Show Imaging Survey
No Show Survey 2900-0876-004, 2900-0876-003 ,  
OPIA/VEO Customer Survey OPIA/VEO Customer Survey
Office of Resolution Management, Diversity & Inclusion (ORMDI) Brand Health Survey 2900-0876-AC1
Outpatient Services Surveys 2900-0876-V3, 2900-0876-V1, 2900-0876-V4, 2900-0876-V5, 2900-0876-V2 ,   ,   ,   ,  
Preferences for Care During Covid Survey 2900-0876-C2
Readjustment Counseling Services (RCS) Vet Center Survey 2900-0876-RCS Survey Wireframes
Same Day Services Survey 2900-08767-S1
Telemedicine 2900-0876-AB1, 2900-AB3, 2900-0876-AB2, 2900-0876-AB4, 2900-0876-AB5, 2900-0876-AB6 ,   ,   ,   ,   ,  
Transition Care and Management VA Liaison Survey 2900-0876-Transition Care and Management VA Liaiso
VA.gov A-11 Survey 2900-0876-Q2
VBA Contact Center Survey 2020-2900-0876-S1
VEAC Survey 2900-0876-VEAC Survey Wireframe
VHA Inpatient Survey 2900-0876 - VHA Inpatient Survey wireframe
Veterans Safety Survey 2900-0876-Veterans Safety 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