Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA, VBA, VHA)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
NAC CSAS Voice of the Customer (VOC) Survey_OMB 2900-0770	Form and Instruction	New	Repair queued
Form Survey VBA 2022 Life Insurance Call Center Satisfaction Questionnaire	Form	New	Repair queued
Form 2900-0770 Survey of the Handling of Unclaimed Veteran Remains	Form and Instruction	New	Repair queued
Form 2900-0770 Post Career Fair Participant Survey	Form	New	Repair queued
Form 2900-0770 Post Career Fair Employer Survey	Form	New	Repair queued
30-Day FRN_2900-0770_Gen Clearance for Qual Feedback on Agency Serv Delivery_pub 09282020.pdf	Supplementary Document	Uploaded 2020-09-28	Available
60-Day FRN_2900-0770_Gen Clearance for Qual Feedback on Agency Serv Delivery_pub 07232020.pdf	Supplementary Document	Uploaded 2020-09-21	Available
Generic PRA Clearance Request Template_2020.docx	Supplementary Document	Uploaded 2020-07-15	Available
2900-0770_Qualitative Feedback_Supporting Statement B_revised 09282020.docx	Supporting Statement B	Uploaded 2020-09-28	Available
(NCA VBA VHA )- PRA Qualitative Feedback_Supporting Statement A_revised 09282020.docx	Supporting Statement A	Uploaded 2020-09-28	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
262611	VBA Customer Satisfaction Survey	Other-Survey	New
261619	VCP Community Organization Needs Assessment Survey	Other-Survey	New
261569	Accessibility of Mammography Services - Veteran and Community Facility Surveys	Other-Survey	New
261501	Whole Health Well-Being Program - Veteran Satisfaction Survey	Other-Survey	New
261492	Physical Medicine & Rehabilitation (PM&R) Services - Patient Satisfaction Survey (VACT HCS)	Other-Survey	New
261376	VCL "Dial 988 then Press 1" Media Campaign Effectiveness Evaluation - Focus Groups	Other-Focus Group Guide	New
261372	VCL "Dial 988 then Press 1" Media Campaign Effectiveness Evaluation (Survey)	Other-Survey	New
261149	Veteran Dental Care Utilization Survey	Other-Survey	New
261129	National Acquisition Center (NAC) Commodities and Services Acquisition Service (CSAS) Voice of the Customer (VOC) Survey	Form and Instruction	New	NAC CSAS Voice of the Customer (VOC) Survey_OMB 2900-0770
261082	Vet Center RCS Awareness Survey	Other-Survey	New
261021	Endoscopy Unit Patient Satisfaction Survey (VACT HCS)	Other-Survey	New
260897	Military2VA Post-9/11 Case Management Program Satisfaction Surveys	Other-Survey	New
260483	DEI Veterans Focus Group Assessments (VA Puget Sound)	Other-Focus Group Guide	New
259452	Close to Me Program - Patient Satisfaction Survey (CBOC)	Other-Survey	New
258551	Resident Physician Clinic Visit - Patient Satisfaction Survey	Other-Survey	New
258201	Young Minority Women Veterans VA Care Satisfaction Surveys	Other-Survey	New
258157	Primary Family Caregiver Financial and Legal Services Survey	Other-Survey	New
257293	Life Insurance Call Center Satisfaction Questionnaire	Form	New	VBA 2022 Life Insurance Call Center Satisfaction Questionnaire
257005	Loan Guaranty Service (LGY) Technology Customer Satisfaction Survey	Other-Survey	New
256478	Same Day Service (SDS) Patient Satisfaction Surveys	Other-Survey	New
255727	Financial Education and Literacy 4 Veterans Survey	Other-Survey	New
255374	James A Haley Veterans Hospital (JAHVH) - Quality Improvement & Clinical Research Studies Registry Survey	Other-Registry Survey	New
254947	Vocational Rehabilitation Services (VRS) Employment Program Satisfaction Surveys	Other-Survey	New
254428	Intimate Partner Violence (IPV) Post-Group Satisfaction Survey	Other-Survey	New
254380	Veteran Cultural Care Needs Satisfaction Survey	Other-Survey	New
253958	Women Veterans Network (WoVeN) - Peer Group Satisfaction Survey	Other-Survey	New
253865	SURVEY OF THE HANDLING OF UNCLAIMED VETERAN REMAINS	Form and Instruction	New	Survey of the Handling of Unclaimed Veteran Remains
253726	MOVE! Weight Management Program for Veterans - Mid-Program & Post-Program Satisfaction Surveys	Other-Survey	New
252600	Network of Support Pilot Survey PL 116-214	Other-survey	New
252209	Dialysis Patient Satisfaction Survey - Lebanon VAMC	Other-Survey	New
251954	Collaborative Exploration of Viable Extended Reality (CEVER) Customer Satisfaction Survey	Other-Survey	New
251893	Community Living Center (CLC) Survey (VISN 1-Bedford)	Other-Survey	New
251802	Veteran Class/Service Satisfaction Survey (VSSS) - VISN 10	Other-Survey	New
251500	Building Better Caregivers (BBC) Alumni Community - Satisfaction Survey	Other-Survey	New
251346	National Caregiver Training Program - Participant Satisfaction Survey	Other-Survey	New
251316	Building Better Caregivers (BBC) Training Workshop - Satisfaction Survey	Other-Survey	New
251220	Peer Support Outreach Center (PSOC) - Client Satisfaction Questionnaire (CSQ) & Peer Specialist Services Assessment	Other-Survey	New
250810	Veterans Health Education Class Satisfaction Survey - OVAHCS	Other-Survey	New
250637	VRRAP Experience Survey and VRRAP Enrollment vs Eligible Survey	Other-Survey	New
250554	Veteran Hybrid Tele-Neuropsychological Evaluation - Satisfaction Survey	Other-Survey	New
250529	VA Trainee Satisfaction Survey (VA-TSS)	Other-Survey	New
250428	VHA OCC FOIA & Privacy Office - Customer Satisfaction Survey	Other-Survey	New
250410	Veterans Transportation Service (VTS) - Customer Satisfaction Survey (VISN 10)	Other-Survey	New
249973	Erie VAMC Lactation Consultant Services Survey	Other-Survey	New
249682	Primary Care Mental Health Integration (PCMHI) Services - Virtual Care Survey	Other-Survey	New
249549	CT-GC Self-Testing Program Survey	Other-Survey	New
249308	Healthy Teaching Kitchen (HTK) Virtual Class Evaluation	Other-Survey	New
249095	Survey of Veterans Utilizing Peer Specialist Services	Other-Survey	New
249075	Community Residential Care (CRC) Program Veteran Survey	Other-Survey	New
249073	Medical Foster Home (MFH) Program Veteran & Caregiver Surveys	Other-Survey	New
249055	Intensive Community Mental Health Recovery Services (ICMHRS) Veteran Satisfaction Surveys	Other-Survey	New
249041	Post Career Fair Participant Survey	Form	New	Post Career Fair Participant Survey
249028	Post Career Fair Employer Survey	Form	New	Post Career Fair Employer Survey
248755	Positive Airway Pressure (PAP) Supply Program Satisfaction Survey	Other-Survey	New
248087	Telerehabilitation Enterprise Wide Initiative (TREWI) Patient Satisfaction Survey	Other-Survey	New
247703	Survey of Suicide Prevention Care Standards Among VCC Providers	Other-Survey	New
247105	NCHS Breast Cancer Wellness Recovery - Peer Support Need Questionnaire	Other-Questionnaire	New
245972	VBA OSE Comms Materials Survey	Other-Survey questions	New
245948	VET TEC Experience Survey	Other-SURVEY	New
244885	STEMText Survey	Other-	New

ICR Details

OMB Control No: 2900-0770	ICR Reference No: 202007-2900-004
Status: Historical Active	Previous ICR Reference No: 201710-2900-001
Agency/Subagency: VA	Agency Tracking No: 2900-0770
Title: Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA, VBA, VHA)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/20/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/29/2020
Terms of Clearance: OMB approves this collection for a period of three years. To request approval of information collections under this generic approval, the agency must do the following: 1) Unless an agency is using multiple modes of collection (e.g., paper forms and electronic submissions), provide a Generic Clearance Submission Template for each Instrument; 2) If the agency is using multiple modes of collection (e.g., paper forms and electronic submissions), the same Generic Clearance Submission Template may be used for both instruments; 3) each Generic Clearance Submission Template must be uploaded as a Supplementary document using a naming convention that allows the public to identify the associated instrument; 4) submit no more than five Generic Submission Templates with each request. ORIA does not authorize VA to proceed with a Generic IC after a fixed number of days.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2023	36 Months From Approved	11/30/2020
Responses	368,500	0	335,000
Time Burden (Hours)	235,584	0	300,000
Cost Burden (Dollars)	0	0	0

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Abstract: The generic clearance will be used to collect qualitative feedback on VA's services or products delivery. VA will seek customer and stakeholder perceptions, experiences, and expectations on its services or products delivery. The data collected will be used to improve delivery of products or services in areas where needed.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Setting Customer Service Standard
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 44581	07/23/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 60881	09/28/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 60

table that charts list of burden

IC Title	Form No.	Form Name
Accessibility of Mammography Services - Veteran and Community Facility Surveys
Building Better Caregivers (BBC) Alumni Community - Satisfaction Survey
Building Better Caregivers (BBC) Training Workshop - Satisfaction Survey
CT-GC Self-Testing Program Survey
Close to Me Program - Patient Satisfaction Survey (CBOC)
Collaborative Exploration of Viable Extended Reality (CEVER) Customer Satisfaction Survey
Community Living Center (CLC) Survey (VISN 1-Bedford)
Community Residential Care (CRC) Program Veteran Survey
DEI Veterans Focus Group Assessments (VA Puget Sound)
Dialysis Patient Satisfaction Survey - Lebanon VAMC
Endoscopy Unit Patient Satisfaction Survey (VACT HCS)
Erie VAMC Lactation Consultant Services Survey
Financial Education and Literacy 4 Veterans Survey
Healthy Teaching Kitchen (HTK) Virtual Class Evaluation
Intensive Community Mental Health Recovery Services (ICMHRS) Veteran Satisfaction Surveys
Intimate Partner Violence (IPV) Post-Group Satisfaction Survey
James A Haley Veterans Hospital (JAHVH) - Quality Improvement & Clinical Research Studies Registry Survey
Life Insurance Call Center Satisfaction Questionnaire	Survey	VBA 2022 Life Insurance Call Center Satisfaction Questionnaire
Loan Guaranty Service (LGY) Technology Customer Satisfaction Survey
MOVE! Weight Management Program for Veterans - Mid-Program & Post-Program Satisfaction Surveys
Medical Foster Home (MFH) Program Veteran & Caregiver Surveys
Military2VA Post-9/11 Case Management Program Satisfaction Surveys
NCHS Breast Cancer Wellness Recovery - Peer Support Need Questionnaire
National Acquisition Center (NAC) Commodities and Services Acquisition Service (CSAS) Voice of the Customer (VOC) Survey	N/A	NAC CSAS Voice of the Customer (VOC) Survey_OMB 2900-0770
National Caregiver Training Program - Participant Satisfaction Survey
Network of Support Pilot Survey PL 116-214
Peer Support Outreach Center (PSOC) - Client Satisfaction Questionnaire (CSQ) & Peer Specialist Services Assessment
Physical Medicine & Rehabilitation (PM&R) Services - Patient Satisfaction Survey (VACT HCS)
Positive Airway Pressure (PAP) Supply Program Satisfaction Survey
Post Career Fair Employer Survey	2900-0770	Post Career Fair Employer Survey
Post Career Fair Participant Survey	2900-0770	Post Career Fair Participant Survey
Primary Care Mental Health Integration (PCMHI) Services - Virtual Care Survey
Primary Family Caregiver Financial and Legal Services Survey
Resident Physician Clinic Visit - Patient Satisfaction Survey
STEMText Survey
SURVEY OF THE HANDLING OF UNCLAIMED VETERAN REMAINS	2900-0770	Survey of the Handling of Unclaimed Veteran Remains
Same Day Service (SDS) Patient Satisfaction Surveys
Survey of Suicide Prevention Care Standards Among VCC Providers
Survey of Veterans Utilizing Peer Specialist Services
Telerehabilitation Enterprise Wide Initiative (TREWI) Patient Satisfaction Survey
VA Trainee Satisfaction Survey (VA-TSS)
VBA Customer Satisfaction Survey
VBA OSE Comms Materials Survey
VCL "Dial 988 then Press 1" Media Campaign Effectiveness Evaluation (Survey)
VCL "Dial 988 then Press 1" Media Campaign Effectiveness Evaluation - Focus Groups
VCP Community Organization Needs Assessment Survey
VET TEC Experience Survey
VHA OCC FOIA & Privacy Office - Customer Satisfaction Survey
VRRAP Experience Survey and VRRAP Enrollment vs Eligible Survey
Vet Center RCS Awareness Survey
Veteran Class/Service Satisfaction Survey (VSSS) - VISN 10
Veteran Cultural Care Needs Satisfaction Survey
Veteran Dental Care Utilization Survey
Veteran Hybrid Tele-Neuropsychological Evaluation - Satisfaction Survey
Veterans Health Education Class Satisfaction Survey - OVAHCS
Veterans Transportation Service (VTS) - Customer Satisfaction Survey (VISN 10)
Vocational Rehabilitation Services (VRS) Employment Program Satisfaction Surveys
Whole Health Well-Being Program - Veteran Satisfaction Survey
Women Veterans Network (WoVeN) - Peer Group Satisfaction Survey
Young Minority Women Veterans VA Care Satisfaction Surveys

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ICR Summary of Burden

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	368,500	335,000	0	33,500	0	0
Annual Time Burden (Hours)	235,584	300,000	0	-64,416	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: VA PRA reviewed previous estimated respondent and burden numbers -- and has adjusted these to reflect projected annual respondents and burden hours under 2900-0770 for the next three years. NOTE: The NOA dated 09/29/2017 shows that OMB approved 214,167 burden hours -- this was the burden hour number published in the 60- and 30-day FRNs in 2017. However, on 10/3/2017, OMB approved an increase in the burden hours to 300,000 -- as a non-substantive change to an approved collection. At this time, VA estimates the number of burden hours for the next three years to be 235,584.

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Annual Cost to Federal Government: $385,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/29/2020

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