VA.gov A-11 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⚠️ Notice: This information collection may be referencing outdated material.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-Q2 VA.gov A-11 Survey Form and Instruction
2900-0876-Q2 VA.Gov A-11 Survey Questions Medallia VA Comment Card Questions (004).xlsx Form and Instruction
A-11 Fast-Track Clearance Request VA.gov Trust Metrics (004).docx Survey Requirements Document IC Document

Information Collection (IC) Details

IC Title:	VA.gov A-11 Survey	Agency IC Tracking Number:	2900-0876-Q1

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	2900-0876-Q2	VA.Gov A-11 Survey Questions	Medallia VA Comment Card Questions (004).xlsx		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 40,000	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	40,000	40,000
Annual IC Time Burden (Hours)	2,000	2,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Survey Requirements Document	A-11 Fast-Track Clearance Request VA.gov Trust Metrics (004).docx	07/27/2020

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