uSPEQ® Consumer Experience Survey (Rehabilitation)

Forms and Documents

Document Name	Status
Form VA Form 10-0467 uSPEQ® Consumer Experience Survey (Rehabilitation) Form	Unchanged
30-day FRN_uSPEQ Consumer Experience_2900-0752_published 09282021.pdf Supplementary Document	2021-09-28
60-day FRN_uSPEQ Consumer Experience_2900-0752_published 06302021.pdf Supplementary Document	2021-09-20
Supporting Statement A_uSPEQ Consumer Experience Survey_2900-0752_updated Oct 2021.docx Supporting Statement A	2021-10-28
Supporting Statement B_uSPEQ Survey_2900-0752_Jul 2021.docx Supporting Statement B	2021-10-28

IC Document Collections

IC ID	Document Title	Status
187874	uSPEQ® Consumer Experience Survey (Rehabilitation) Form	Unchanged

ICR Details

OMB Control No: 2900-0752	ICR Reference No: 202103-2900-007
Status: Received in OIRA	Previous ICR Reference No: 201703-2900-002
Agency/Subagency: VA	Agency Tracking No: 2900-0752
Title: uSPEQ® Consumer Experience Survey (Rehabilitation)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/29/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	384,000	0
Time Burden (Hours)	32,000	0
Cost Burden (Dollars)	0	0

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Abstract: The uSPEQ® is a confidential, anonymous, and scientifically-tested consumer reporting system that gives persons served a voice in their services. There is a current absence of an existing survey model that is psychometrically sound and nationally benchmarked for survey of consumer experiences in VA rehabilitation programs. VA rehabilitation programs are committed to adopting the uSPEQ® survey to assess outcome measures related to patient perceptions of and perspectives regarding rehabilitation experiences. VA recognizes that adoption of this survey provides a systems approach and benchmarking capability for patient assessed outcomes of care.

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Authorizing Statute(s): US Code: 38 USC Chapter 17 Name of Law: Hospital, Nursing Home, Domiciliary, and Medical Care
  

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:
	86 FR 34844	06/30/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 53732	09/28/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
uSPEQ® Consumer Experience Survey (Rehabilitation)	VA Form 10-0467	uSPEQ Consumer Experience Survey (Rehabilitation)

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ICR Summary of Burden

	Total Request	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	384,000	0	0	0	0	384,000
Annual Time Burden (Hours)	32,000	0	0	0	0	32,000
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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $960,000

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.     Yes

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.     Yes

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: 10/29/2021

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