Information Collection

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

IC 192326 under ICR 202411-2900-011 · OMB 2900-0764.

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 (DPSS)	Form and Instruction
10-10070 Dental Care Patient Satisfaction Survey (DPSS) 2900-0764_Survey of Healthcare Exp of Pts - Dental Care Patient Satisfaction Survey (DPSS)_rev Jan 2025.docx	Form and Instruction
10-10070 Dental Care Patient Satisfaction Survey (DPSS) 2900-0764_Survey of Healthcare Exp of Pts - Dental Care Patient Satisfaction Survey (DPSS)_rev Jan 2025.docx	Form and Instruction
10-10070 Dental Care Patient Satisfaction Survey (DPSS) - Online 2900-0764_Survey of Healthcare Exp of Pts - Dental Care Pt Satis Survey_Screenshots_v4_Dec 2024.pptx	Form and Instruction
10-10070 Dental Care Patient Satisfaction Survey (DPSS) - Online 2900-0764_Survey of Healthcare Exp of Pts - Dental Care Pt Satis Survey_Screenshots_v4_Dec 2024.pptx	Form and Instruction

IC Title:

Agency IC Tracking Number:

VHA-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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10-10070	Dental Care Patient Satisfaction Survey (DPSS)	2900-0764_Survey of Healthcare Exp of Pts - Dental Care Patient Satisfaction Survey (DPSS)_rev Jan 2025.docx		No		Paper Only
Form and Instruction	10-10070	Dental Care Patient Satisfaction Survey (DPSS) - Online	2900-0764_Survey of Healthcare Exp of Pts - Dental Care Pt Satis Survey_Screenshots_v4_Dec 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: 25 %

table that charts list of burden
	Approved	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.