Information Collection

Survey of Healthcare Experiences of Patients -- Dental Care Patient Satisfaction Survey

IC 192326 under ICR 202411-2900-009 · OMB 2900-0764.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0764 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-10070 Survey of Healthcare Experiences of Patients -- Dental Care Patient Satisfaction Survey	Form and Instruction
Dental Patient Satis Survey_DPSS_Online Survey_client script_2024.docx	Other-Online Script
Dental Patient Satis Survey_DPSS_Online Survey_client script_2024.docx	Other-Online Script
VA Dental Care Patient Satisfaction Survey (DPSS)_Online Screenshots_Oct 2024.pptx	Other-Screenshots
VA Dental Care Patient Satisfaction Survey (DPSS)_Online Screenshots_Oct 2024.pptx	Other-Screenshots
10-10070 Dental Care Patient Satisfaction Survey (DPSS) Survey of Healthcare Experiences of Patients - Dental Care Patient Satisfaction Survey_2900-0764_2024.docx	Form and Instruction
10-10070 Dental Care Patient Satisfaction Survey (DPSS) Survey of Healthcare Experiences of Patients - Dental Care Patient Satisfaction Survey_2900-0764_2024.docx	Form and Instruction

IC Title:

Survey of Healthcare Experiences of Patients -- Dental Care Patient Satisfaction Survey

Agency IC Tracking Number:

2900-0764

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10-10070	Dental Care Patient Satisfaction Survey (DPSS)	Survey of Healthcare Experiences of Patients - Dental Care Patient Satisfaction Survey_2900-0764_2024.docx	No		Paper Only
Other-Online Script			Dental Patient Satis Survey_DPSS_Online Survey_client script_2024.docx	No		Paper Only
Other-Screenshots			VA Dental Care Patient Satisfaction Survey (DPSS)_Online Screenshots_Oct 2024.pptx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	50,400	50,400
Annual IC Time Burden (Hours)	12,600	12,600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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