Information Collection

VISN 1 NCL Phlebotomy Service - Patient Satisfaction Survey

IC 263747 under ICR 202307-2900-013 · OMB 2900-0770.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
VISN 1_NCL Patient Satisfaction Survey_final_2023.docx	Other-Survey
Generic Supporting Statement_VISN 1 - NCL Patient Satisfaction Survey_updated Nov 2023.docx Generic Supporting Statement - VISN 1 NCL Phlebotomy Service - Patient Satisfaction Survey - updated Nov 2023	IC Document

IC Title:

Agency IC Tracking Number:

VHA-2900-0770

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Survey			VISN 1_NCL Patient Satisfaction Survey_final_2023.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Supporting Statement - VISN 1 NCL Phlebotomy Service - Patient Satisfaction Survey - updated Nov 2023	Generic Supporting Statement_VISN 1 - NCL Patient Satisfaction Survey_updated Nov 2023.docx	11/30/2023

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