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Survey of Healthcare Experiences of Patients -- Dental Care Patient Satisfaction Survey (DPSS)
Survey of Healthcare Experiences of Patients -- Dental Care Patient Satisfaction Survey (DPSS)
OMB: 2900-0764
IC ID: 192326
OMB.report
VA
OMB 2900-0764
ICR 202411-2900-011
IC 192326
( )
Documents and Forms
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) - Online
2900-0764_Survey of Healthcare Exp of Pts - Dental Care Pt Satis Survey_Screenshots_v4_Dec 2024.pptx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Survey of Healthcare Experiences of Patients -- Dental Care Patient Satisfaction Survey (DPSS)
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:
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
Federal Enterprise Architecture Business Reference Module
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 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
50,400
0
0
0
0
50,400
Annual IC Time Burden (Hours)
12,600
0
0
0
0
12,600
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.