Covid-19 Veteran Customer Satisfaction Survey

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0876 can be found here:

Documents and Forms

Document Name Document Type
Form 2900-0876-07A Covid-19 Veteran Customer Satisfaction Survey Form
2900-0876-07A Covid-19 Telehealth Survey VA Telehealth Covid Survey 061520.pdf Form
2900-0876-07B Covid-19 Post-Visit Survey VA Post Visit Covid Survey 061520.pdf Form
2900-0876-07C Covid-19 General Survey VA General Covid Survey 061520.pdf Form
A-11 Fast-Track Clearance Request Template_Covid19 (005).docx Survey Overview and Specifications IC Document
COVID VSignals Survey Sampling Plan final 06152020.docx Survey Sample Plan IC Document

Information Collection (IC) Details

IC Title:	Covid-19 Veteran Customer Satisfaction Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	2900-0876-07A	Covid-19 Telehealth Survey	VA Telehealth Covid Survey 061520.pdf	Yes	Yes	Fillable Fileable
Form	2900-0876-07B	Covid-19 Post-Visit Survey	VA Post Visit Covid Survey 061520.pdf	Yes	Yes	Fillable Fileable
Form	2900-0876-07C	Covid-19 General Survey	VA General Covid Survey 061520.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,800	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	10,800	10,800
Annual IC Time Burden (Hours)	540	540
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Survey Overview and Specifications	A-11 Fast-Track Clearance Request Template_Covid19 (005).docx	06/16/2020
Survey Sample Plan	COVID VSignals Survey Sampling Plan final 06152020.docx	06/15/2020

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