Information Collection Request

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

ICR 202210-2900-003 · OMB 2900-0876 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 2900-0876 ECCC – V 2900-0876 ECCC – VA Loan Guaranty Form and Instruction New Repair queued
Form 2900-0876 Scheduling Wireframe Form and Instruction New Repair queued
Form 2900-0876 RX Wireframe Form and Instruction New Repair queued
Form 2900-0876 Emergency Wireframe Form and Instruction New Repair queued
Form 2900-0876 Choosing Wireframe Form and Instruction New Repair queued
Form 2900-0876 Billing Wireframe Form and Instruction New Repair queued
Form 2900-0876 Attending Wireframe Form and Instruction New Repair queued
Form 2900-0876 ECCC VA Health Connect Wireframe OMB rev 3 3 25 Form and Instruction New Repair queued
Form 2900-0876 Applying for benefits survey OMB rev 2 26 25 Form and Instruction New Repair queued
Form 2900-0876 Receiving Ed Benefits Survey OMB rev 2 26 25 Form and Instruction New Repair queued
Form 2900-0876 Enrolling in School Survey OMB rev 2 26 25 Form and Instruction New Repair queued
Form VFCE VEAC Exit Sur VFCE VEAC Exit Survey Final Form and Instruction New Repair queued
Form VFCE VEAC Email Su VFCE VEAC Email Survey Final Form and Instruction New Repair queued
Form Annie Text Messagi Annie Text Messaging Survey Question Changes Form and Instruction New Repair queued
Form 2900-0876 OSDBU Lunch N Learn Wireframe Form and Instruction New Repair queued
Form 2900-0876 OSDBU CS Wireframe OMB 12 12 24 Form and Instruction New Repair queued
Form OSDBU Lunch N Lear OSDBU Lunch N Learn Wireframe Form and Instruction New Repair queued
Form OSDBU CS Wireframe OSDBU CS Wireframe Form and Instruction New Repair queued
Form OSDBU IVR Wirefram OSDBU IVR Wireframe v2 Form and Instruction New Repair queued
Form Personalized Caree Personalized Career Planning and Guidance Survey Form and Instruction New Repair queued
Form Wireframe Template Wireframe Template 6.9.23 1 VFCE Sturgis V2 Form and Instruction New Repair queued
Form Healthy Teaching K Healthy Teaching Kitchen Final v2 RL Edits Form and Instruction New Repair queued
Form 2900-0876 After Vi 2900-0876 After Visit Summary Form and Instruction New Repair queued
Form 2900-0876 MyHealth 2900-0876 MyHealtheVet and Oracle Health Survey Form and Instruction New Repair queued
Form ECCC Member Servic ECCC Member Services Wireframe Form and Instruction New Repair queued
Form 2023-03-08 Compens 2023-03-08 Compensation Claims Questions_FINAL Form and Instruction New Repair queued
Form Survivor Survey Survivor Survey Form and Instruction New Repair queued
Form 2900-0876 Teleheal 2900-0876 Telehealth Store and Forward Result Form and Instruction New Repair queued
Form ECCC Vet Center Wi ECCC Vet Center Wireframe Form and Instruction New Repair queued
Form Completing VR&E su Completing VR&E survey wireframe Form and Instruction New Repair queued
Form Discontinuing from Discontinuing from VRE survey wireframe Form and Instruction New Repair queued
Form Participating VR&E Participating VR&E survey wireframe Form and Instruction New Repair queued
Form PCT survey PCT survey Form and Instruction New Repair queued
Form Indiana WF 1.12.24 Indiana WF 1.12.24 Form and Instruction New Repair queued
Form 2900-0876 Clinical 2900-0876 Clinical Screening Tool Survey Form and Instruction New Repair queued
Form VIP Bootcamp Satis VIP Bootcamp Satisfaction Survey Form and Instruction New Repair queued
Form Compassionate Cont Compassionate Contact Corps - Volunteer Form and Instruction New Repair queued
Form Compassionate Cont Compassionate Contact Corps - Veteran Form and Instruction New Repair queued
Form MOVE! Maintenance MOVE! Maintenance Pilot Program Survey Form and Instruction New Repair queued
Form VSDHF Engagement S VSDHF Engagement Survey Wireframe Form and Instruction New Repair queued
Form 2900-0876 Telemedi 2900-0876 Telemedicine Form and Instruction New Repair queued
Form Anesthesia Patient Anesthesia Patient Satisfaction Survey Form and Instruction New Repair queued
Form NFS Wireframe NFS Wireframe Form and Instruction New Repair queued
Form Homelessness WF 6. Homelessness WF 6.7.23 v3 Form and Instruction New Repair queued
Form VRCN Wireframe 6.1 VRCN Wireframe 6.15.23 Form and Instruction New Repair queued
Form ECCC - VET HOME Su ECCC - VET HOME Survey Wireframes Form and Instruction New Repair queued
Form CLC WF with footer CLC WF with footer & logic & priv 5.22.23 Form and Instruction New Repair queued
Form Northern Arizona D Northern Arizona Dental Service survey Form and Instruction New Repair queued
Form Under 40 Trust WF Under 40 Trust WF 4.27.23 Form and Instruction New Repair queued
Form Solid Start Survey Solid Start Survey Wires Form and Instruction New Repair queued
Form Promise to Address Promise to Address Comprehensive Toxics (PACT) Act Outreach survey Form and Instruction New Repair queued
Form Compensation Surve Compensation Survey Form and Instruction New Repair queued
Form Military Exposures Military Exposures Care Survey 2023_03_06 Form and Instruction New Repair queued
Form MOVE! Maintenance MOVE! Maintenance Pilot Program Survey Wireframe Form and Instruction New Repair queued
Form Long Covid Survey Long Covid Survey Wires 2023_02_10 Form and Instruction New Repair queued
Form VA.gov A11 Questio VA.gov A11 Questionnaire - 01202023 HF Form and Instruction New Repair queued
Form VA.gov VFS - ChatB VA.gov VFS - ChatBot Questionnaire - 01202023 HF Form and Instruction New Repair queued
Form VA.gov VFS - Searc VA.gov VFS - Search Questionnaire - 01202023 HF Form and Instruction New Repair queued
Form VA.gov VFS Questio VA.gov VFS Questionnaire - 01202023 HF Form and Instruction New Repair queued
Form Annie Text Messagi Annie Text Messaging Survey Form and Instruction New Repair queued
Form VRE CH31 - Discont VRE CH31 - Discontinuing from VRE Survey Form and Instruction New Available
Form VRE CH31 - Complet VRE CH31 - Completing VR&E Survey Wireframes Form and Instruction New Available
Form VRE CH31 - Partici VRE CH31 - Participating in VR&E Survey Form and Instruction New Available
Form VRE CH31 - Learnin VRE CH31 - Learning and Applying for VR&E Survey Form and Instruction New Available
30-day FRN 2900-0876.pdf Supplementary Document Uploaded 2022-12-30 Repair queued
60 Day FRN.pdf Supplementary Document Uploaded 2022-12-21 Repair queued
A-11 30-day FRN_ 2900-0876 17Oct2022.docx Supplementary Document Uploaded 2022-10-17 Repair queued
A-11 60-day FRN_ 2900-0876 17Oct2022.docx Supplementary Document Uploaded 2022-10-17 Repair queued
Supporting Statement A for Agencies A_11 Section 280 Improving Customer Experience.docx Supporting Statement A Uploaded 2022-10-13 Repair queued
A-11 Fast-Track Clearance Request Template.docx Supplementary Document Uploaded 2020-03-13 Repair queued
Supporting Statement B for Agencies_A 11 Section 280 Improving Customer Experience.docx Supporting Statement B Uploaded 2022-10-13 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
274354 ECCC – VA Loan Guaranty Form and Instruction New2900-0876 ECCC – VA Loan Guaranty
274194 Veteran Transportation Surveys Other-Survey Instrument New
273946 Office of Community Care – IVC Survey Collection Form and Instruction NewScheduling Wireframe
273946 Office of Community Care – IVC Survey Collection Form and Instruction NewRX Wireframe
273946 Office of Community Care – IVC Survey Collection Form and Instruction NewEmergency Wireframe
273946 Office of Community Care – IVC Survey Collection Form and Instruction NewChoosing Wireframe
273946 Office of Community Care – IVC Survey Collection Form and Instruction NewBilling Wireframe
273946 Office of Community Care – IVC Survey Collection Form and Instruction NewAttending Wireframe
273856 ECCC – IVC VA Health Connect Form and Instruction NewECCC VA Health Connect Wireframe OMB rev 3 3 25
273754 VBA Education Survey Form and Instruction NewApplying for benefits survey OMB rev 2 26 25
273754 VBA Education Survey Form and Instruction NewReceiving Ed Benefits Survey OMB rev 2 26 25
273754 VBA Education Survey Form and Instruction NewEnrolling in School Survey OMB rev 2 26 25
273477 VA OIG Viewer Interest Project Other-Survey Instrument New
272998 Veterans Family and Community Engagement (VFCE) Veterans Engagement Action Center (VEAC) Email & Exit Surveys Form and Instruction NewVFCE VEAC Exit Survey Final
272998 Veterans Family and Community Engagement (VFCE) Veterans Engagement Action Center (VEAC) Email & Exit Surveys Form and Instruction NewVFCE VEAC Email Survey Final
272962 Annie Text Messaging Survey Question Changes Form and Instruction NewAnnie Text Messaging Survey Question Changes
272799 Office of Small & Disadvantaged Business Utilization (OSDBU) Customer Service & Lunch "N" Learn Survey Updates Form and Instruction NewOSDBU Lunch N Learn Wireframe
272799 Office of Small & Disadvantaged Business Utilization (OSDBU) Customer Service & Lunch "N" Learn Survey Updates Form and Instruction NewOSDBU CS Wireframe OMB 12 12 24
272799 Office of Small & Disadvantaged Business Utilization (OSDBU) Customer Service & Lunch "N" Learn Survey Updates Form and Instruction NewOSDBU Lunch N Learn Wireframe
272799 Office of Small & Disadvantaged Business Utilization (OSDBU) Customer Service & Lunch "N" Learn Survey Updates Form and Instruction NewOSDBU CS Wireframe
272611 VHA Community Living Center - Add SCI/D question Other-Survey Instrument New
272507 VHA ALS Customer Experience Survey Other-Survey Instrument New
272500 Beneficiary Travel Self Service System (BTSSS) Survey Question updates Other-Survey Instrument New
272432 Enterprise Contact Center Council (ECCC) Office of Small & Disadvantaged Business Utilization (OSDBU) Interactive Voice Response (IVR) Survey Form and Instruction NewOSDBU IVR Wireframe v2
272393 Personalized Career Planning and Guidance (PGPC) Survey Form and Instruction NewPersonalized Career Planning and Guidance Survey
269874 Annie Text Messaging Survey Question Changes Other-Survey Instrument New
269793 Sturgis Rally VetFest 2024 Mini Registration Form and Instruction NewWireframe Template 6.9.23 1 VFCE Sturgis V2
269523 Healthy Teaching Kitchen Survey Form and Instruction NewHealthy Teaching Kitchen Final v2 RL Edits
269404 After Visit Summary Survey Form and Instruction New2900-0876 After Visit Summary
269189 MyHealtheVet and Oracle Health Survey Form and Instruction New2900-0876 MyHealtheVet and Oracle Health Survey
269049 Member Services Contact Center Survey Form and Instruction NewECCC Member Services Wireframe
268403 VBA Compensation Survey - Increase Burden Form and Instruction New2023-03-08 Compensation Claims Questions_FINAL
268074 Blind and Low Vision Rehabilitation Survey Other-Survey Instrument New
267667 survivor Survey Form and Instruction NewSurvivor Survey
267302 Nutrition and Food Service Inpatient Survey - Updated Question Other-Survey Instrument New
266993 VEAC/Outreach Naming Survey Other-Survey Instrument New
266324 Telehealth Store and Forward Result Form and Instruction New2900-0876 Telehealth Store and Forward Result
266009 ECCC Vet Center Form and Instruction NewECCC Vet Center Wireframe
265731 VBA Veteran Readiness and Employment Survey Form and Instruction NewCompleting VR&E survey wireframe
265731 VBA Veteran Readiness and Employment Survey Form and Instruction NewDiscontinuing from VRE survey wireframe
265731 VBA Veteran Readiness and Employment Survey Form and Instruction NewParticipating VR&E survey wireframe
265530 VFCE VEAC Survey - Updated Trust Question Other-Survey Instrument New
265526 Community Living Centers (CLC) Survey-Updated trust question Other-Survey Instrument New
265229 Public Contact Team Survey Form and Instruction NewPCT survey
264539 Indiana Survey Form and Instruction NewIndiana WF 1.12.24
264139 Spanish Benefits Letter Survey Other-Survey Instrument New
262871 Clinical Screening Tool Survey Form and Instruction New2900-0876 Clinical Screening Tool Survey
262578 VIP Bootcamp Satisfaction Survey Form and Instruction NewVIP Bootcamp Satisfaction Survey
262424 Compassionate Contact Corps Survey Form and Instruction NewCompassionate Contact Corps - Volunteer
262424 Compassionate Contact Corps Survey Form and Instruction NewCompassionate Contact Corps - Veteran
262422 Support Staff Post Veterans Experience Action Center (VEAC) Other-Survey Instrument New
262120 Ensuring Awareness of Benefits and Services of NCA Other-Survey Instrument New
261945 Beneficiary Travel Self Service System (BTSSS) Survey Other-Survey Instrument New
261942 MOVE! Maintenance Pilot Program Survey Form and Instruction NewMOVE! Maintenance Pilot Program Survey
261804 Outpatient-Labs and Imaging - Add Mammography Questions Other-Survey Instrument New
261791 VSDHF Engagement Survey Form and Instruction NewVSDHF Engagement Survey Wireframe
261780 Telemedicine Form and Instruction New2900-0876 Telemedicine
261480 Anesthesia Patient Satisfaction Survey Form and Instruction NewAnesthesia Patient Satisfaction Survey
261190 Clinical Contact Center Survey-Update Burden Other-Survey Instrument New
260965 Nutrition & Food Service(NFS) Inpatient Survey Form and Instruction NewNFS Wireframe
260783 Homelessness Survey Form and Instruction NewHomelessness WF 6.7.23 v3
260683 VetResources Community Network (VRCN) Survey Form and Instruction NewVRCN Wireframe 6.15.23
260557 Enterprise Contact Center Council (ECCC) - Veterans Exposure Team-Health Outcomes Military Exposures (VET-HOME) Survey Form and Instruction NewECCC - VET HOME Survey Wireframes
260348 Community Living Center (CLC) Survey Form and Instruction NewCLC WF with footer & logic & priv 5.22.23
260108 Northern Arizona Dental Service survey Form and Instruction NewNorthern Arizona Dental Service survey
259926 Under 40 Trust Project Form and Instruction NewUnder 40 Trust WF 4.27.23
259840 VA Solid Start Survey Form and Instruction NewSolid Start Survey Wires
259612 Promise to Address Comprehensive Toxics (PACT) Act Outreach survey Form and Instruction NewPromise to Address Comprehensive Toxics (PACT) Act Outreach survey
259047 VBA Compensation Survey Form and Instruction NewCompensation Survey
259032 Military Exposure Survey Form and Instruction NewMilitary Exposures Care Survey 2023_03_06
258896 MOVE! Maintenance Pilot Program Form and Instruction NewMOVE! Maintenance Pilot Program Survey Wireframe
258567 Long COVID Surveys Form and Instruction NewLong Covid Survey Wires 2023_02_10
258501 VA.gov A-11 Surveys Form and Instruction NewVA.gov A11 Questionnaire - 01202023 HF
258501 VA.gov A-11 Surveys Form and Instruction NewVA.gov VFS - ChatBot Questionnaire - 01202023 HF
258501 VA.gov A-11 Surveys Form and Instruction NewVA.gov VFS - Search Questionnaire - 01202023 HF
258501 VA.gov A-11 Surveys Form and Instruction NewVA.gov VFS Questionnaire - 01202023 HF
258478 Annie Text Messaging Survey Form and Instruction NewAnnie Text Messaging Survey
258284 VBA Veterans Readiness and Employment (Chapter 31) Surveys Form and Instruction NewVRE CH31 - Discontinuing from VRE Survey
258284 VBA Veterans Readiness and Employment (Chapter 31) Surveys Form and Instruction NewVRE CH31 - Completing VR&E Survey Wireframes
258284 VBA Veterans Readiness and Employment (Chapter 31) Surveys Form and Instruction NewVRE CH31 - Participating in VR&E Survey
258284 VBA Veterans Readiness and Employment (Chapter 31) Surveys Form and Instruction NewVRE CH31 - Learning and Applying for VR&E Survey

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
02/28/2026 36 Months From Approved 03/31/2023
4,012,000 0 3,500,000
344,083 0 1,754,975
0 0 0





Reginfo record details
61
table that charts list of burden
IC Title Form No. Form Name
After Visit Summary Survey 2900-0876 After Visit Summary
Anesthesia Patient Satisfaction Survey Anesthesia Patient Satisfaction Survey
Annie Text Messaging Survey Annie Text Messaging Survey
Annie Text Messaging Survey Question Changes Annie Text Messaging Survey Question Changes
Annie Text Messaging Survey Question Changes
Beneficiary Travel Self Service System (BTSSS) Survey
Beneficiary Travel Self Service System (BTSSS) Survey Question updates
Blind and Low Vision Rehabilitation Survey
Clinical Contact Center Survey-Update Burden
Clinical Screening Tool Survey 2900-0876 Clinical Screening Tool Survey
Community Living Center (CLC) Survey CLC WF with footer & logic & priv 5.22.23
Community Living Centers (CLC) Survey-Updated trust question
Compassionate Contact Corps Survey Compassionate Contact Corps - Volunteer, Compassionate Contact Corps - Veteran ,  
ECCC Vet Center ECCC Vet Center Wireframe
ECCC – IVC VA Health Connect 2900-0876
ECCC – VA Loan Guaranty 2900-0876 ECCC – VA Loan Guaranty
Ensuring Awareness of Benefits and Services of NCA
Enterprise Contact Center Council (ECCC) - Veterans Exposure Team-Health Outcomes Military Exposures (VET-HOME) Survey ECCC - VET HOME Survey Wireframes
Enterprise Contact Center Council (ECCC) Office of Small & Disadvantaged Business Utilization (OSDBU) Interactive Voice Response (IVR) Survey OSDBU IVR Wireframe v2
Healthy Teaching Kitchen Survey Healthy Teaching Kitchen Final v2 RL Edits
Homelessness Survey Homelessness WF 6.7.23 v3
Indiana Survey Indiana WF 1.12.24
Long COVID Surveys Long Covid Survey Wires 2023_02_10
MOVE! Maintenance Pilot Program MOVE! Maintenance Pilot Program Survey Wireframe
MOVE! Maintenance Pilot Program Survey MOVE! Maintenance Pilot Program Survey
Member Services Contact Center Survey ECCC Member Services Wireframe
Military Exposure Survey Military Exposures Care Survey 2023_03_06
MyHealtheVet and Oracle Health Survey 2900-0876 MyHealtheVet and Oracle Health Survey
Northern Arizona Dental Service survey Northern Arizona Dental Service survey
Nutrition & Food Service(NFS) Inpatient Survey NFS Wireframe
Nutrition and Food Service Inpatient Survey - Updated Question
Office of Community Care – IVC Survey Collection 2900-0876, 2900-0876, 2900-0876, 2900-0876, 2900-0876, 2900-0876 ,   ,   ,   ,   ,  
Office of Small & Disadvantaged Business Utilization (OSDBU) Customer Service & Lunch "N" Learn Survey Updates 2900-0876, 2900-0876, OSDBU CS Wireframe, OSDBU Lunch N Learn Wireframe ,   ,   ,  
Outpatient-Labs and Imaging - Add Mammography Questions
Personalized Career Planning and Guidance (PGPC) Survey Personalized Career Planning and Guidance Survey
Promise to Address Comprehensive Toxics (PACT) Act Outreach survey Promise to Address Comprehensive Toxics (PACT) Act
Public Contact Team Survey PCT survey
Spanish Benefits Letter Survey
Sturgis Rally VetFest 2024 Mini Registration Wireframe Template 6.9.23 1 VFCE Sturgis V2
Support Staff Post Veterans Experience Action Center (VEAC)
Telehealth Store and Forward Result 2900-0876 Telehealth Store and Forward Result
Telemedicine 2900-0876 Telemedicine
Under 40 Trust Project Under 40 Trust WF 4.27.23
VA OIG Viewer Interest Project
VA Solid Start Survey Solid Start Survey Wires
VA.gov A-11 Surveys VA.gov A11 Questionnaire - 01202023 HF, VA.gov VFS Questionnaire - 01202023 HF, VA.gov VFS - Search Questionnaire - 01202023 HF, VA.gov VFS - ChatBot Questionnaire - 01202023 HF ,   ,   ,  
VBA Compensation Survey Compensation Survey
VBA Compensation Survey - Increase Burden 2023-03-08 Compensation Claims Questions_FINAL
VBA Education Survey 2900-0876, 2900-0876, 2900-0876 ,   ,  
VBA Veteran Readiness and Employment Survey Participating VR&E survey wireframe, Discontinuing from VRE survey wireframe, Completing VR&E survey wireframe ,   ,  
VBA Veterans Readiness and Employment (Chapter 31) Surveys VRE CH31 - Learning and Applying for VR&E Survey , VRE CH31 - Participating in VR&E Survey , VRE CH31 - Completing VR&E Survey Wireframes, VRE CH31 - Discontinuing from VRE Survey ,   ,   ,  
VEAC/Outreach Naming Survey
VFCE VEAC Survey - Updated Trust Question
VHA ALS Customer Experience Survey
VHA Community Living Center - Add SCI/D question
VIP Bootcamp Satisfaction Survey VIP Bootcamp Satisfaction Survey
VSDHF Engagement Survey VSDHF Engagement Survey Wireframe
VetResources Community Network (VRCN) Survey VRCN Wireframe 6.15.23
Veteran Transportation Surveys
Veterans Family and Community Engagement (VFCE) Veterans Engagement Action Center (VEAC) Email & Exit Surveys VFCE VEAC Email Survey Final, VFCE VEAC Exit Survey Final ,  
survivor Survey Survivor Survey

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 4,012,000 3,500,000 0 512,000 0 0
Annual Time Burden (Hours) 344,083 1,754,975 0 -1,410,892 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


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