Survey of Healthcare Experiences of Patients -- Dental Care Patient Satisfaction Survey (DPSS)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10-10070 Dental Care Patient Satisfaction Survey (DPSS) - Online	Form and Instruction	Modified	Available
Form 10-10070 Dental Care Patient Satisfaction Survey (DPSS)	Form and Instruction	Modified	Available
Form 10-10070 Survey of Healthcare Experiences of Patients -- Dental Care Patient Satisfaction Survey (DPSS)	Form and Instruction	Modified	Repair queued
30-day FRN_2900-0764_Survey of Healthcare Exp of Patients - Dental Care Patient Satis Survey_pub 01282025.pdf	Supplementary Document	Uploaded 2025-01-28	Available
30-day FRN_2900-0764_Survey of Healthcare Exp of Patients - Dental Care Patient Satis Survey_pub 01282025.pdf	Supplementary Document	Uploaded 2025-01-28	Repair queued
60-day FRN_2900-0764_Survey of Healthcare Exp of Patients - Dental Care Patient Satis Survey_pub 11222024.pdf	Supplementary Document	Uploaded 2025-01-17	Available
60-day FRN_2900-0764_Survey of Healthcare Exp of Patients - Dental Care Patient Satis Survey_pub 11222024.pdf	Supplementary Document	Uploaded 2025-01-17	Repair queued
SSA _2900-0764_Survey of Healthcare Exp of Pts - Dental Care Patient Satis Survey (DPSS)_updated 01282025.docx	Supporting Statement A	Uploaded 2025-01-28	Available
SSA _2900-0764_Survey of Healthcare Exp of Pts - Dental Care Patient Satis Survey (DPSS)_updated 01282025.docx	Supporting Statement A	Uploaded 2025-01-28	Repair queued
Supporting Statement B_2900-0764_Dental Care Patient Satis Survey (DPSS)_updated Dec 2024.docx	Supporting Statement B	Uploaded 2025-01-17	Available
Supporting Statement B_2900-0764_Dental Care Patient Satis Survey (DPSS)_updated Dec 2024.docx	Supporting Statement B	Uploaded 2025-01-17	Missing upstream

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
192326	Survey of Healthcare Experiences of Patients -- Dental Care Patient Satisfaction Survey (DPSS)	Form and Instruction	Modified	Dental Care Patient Satisfaction Survey (DPSS) - Online
192326	Survey of Healthcare Experiences of Patients -- Dental Care Patient Satisfaction Survey (DPSS)	Form and Instruction	Modified	Dental Care Patient Satisfaction Survey (DPSS)
192326	Survey of Healthcare Experiences of Patients -- Dental Care Patient Satisfaction Survey (DPSS)	Form and Instruction	Modified

ICR Details

OMB Control No: 2900-0764	ICR Reference No: 202411-2900-011
Status: Historical Active	Previous ICR Reference No: 202108-2900-020
Agency/Subagency: VA	Agency Tracking No: 2900-0764
Title: Survey of Healthcare Experiences of Patients -- Dental Care Patient Satisfaction Survey (DPSS)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/02/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/28/2025
Terms of Clearance: OIRA approves this revision for only the paper version for one year. The electronic version is not approved. By the end of one year, VA will either discontinue the collection and work with VEO to do a simple customer experience survey or VA will submit an ICR revision that substantially reduces the cost to the government and burden on the public.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2026	36 Months From Approved	05/31/2025
Responses	50,400	0	50,400
Time Burden (Hours)	12,600	0	12,600
Cost Burden (Dollars)	0	0	0

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Abstract: The mission of the Veterans Health Administration (VHA) is to provide high quality medical and dental care to eligible Veterans. Executive Order 12862, dated September 11, 1993, calls for the establishment and implementation of customer service standards, and for agencies to “survey customers to determine the kind and quality of services they want and their level of satisfaction with current services.” The overall purpose of the VHA Office of Dentistry Dental Patient Satisfaction Survey is to systematically obtain information from patients that can be used to identify problems or complaints that need attention and to improve the quality of dental health care services delivered to Veterans. The Office of Dentistry (OOD) currently tracks a number of clinical parameters indicative of quality care (e.g., appropriate use of fluoride products in high caries risk patients, frequency of dental examinations and care provided to medically compelling patients); however, patient satisfaction with this care is not specifically measured. Information obtained from this dental survey will be made readily available to VA Central Office (VACO), Veterans Integrated Service Network (VISN), VHA field staff, and stakeholders as part of the Network Performance Report and via the VA Intranet. This data will be used to demonstrate that VA is providing timely, high quality health care services to patients and to measure improvement toward performance goals. The VHA program office has now included an electronic version of the survey, which is ready to be implemented as an online option for collecting survey responses. Also, changes were made to some survey questions, including updates to the Race & Ethnicity options to reflect current collection requirements.

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

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:
	89 FR 92740	11/22/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 8324	01/28/2025
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Survey of Healthcare Experiences of Patients -- Dental Care Patient Satisfaction Survey (DPSS)	10-10070, 10-10070	Dental Care Patient Satisfaction Survey (DPSS) ,   Dental Care Patient Satisfaction Survey (DPSS) - Online

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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	50,400	50,400	0	0	0	0
Annual Time Burden (Hours)	12,600	12,600	0	0	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $550,720

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: 01/28/2025

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