Information Collection

Covid-19 Veteran Customer Satisfaction Survey

IC 242272 under ICR 202003-2900-011 · OMB 2900-0876.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Covid-19 Veteran Customer Satisfaction Survey

Agency IC Tracking Number:

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	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 %

table that charts list of burden
	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

table that charts IC Documents
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.