VIP Bootcamp Satisfaction Survey

Request for Approval under the “Generic Clearance for Improving
Customer Experience: OMB Circular A-11, Section 280
Implementation”
(OMB Control Number: 2900-0876)
TITLE OF INFORMATION COLLECTION:
Survey

VIP Bootcamp Satisfaction

PURPOSE OF COLLECTION:
VIP Bootcamp is a Primary Care Mental health Integration (PCMHI)
program created as an upstream solution to Mental health Clinic
(MHC/BHIP) access issues and to provide a direct referral system
for PCMHI providers to a comprehensive program that can provide
veterans with the dose of therapy they need at a given time. The
goal of the bootcamp is for PCMHI be space where veterans have
access to an effective and evidenced based dose of treatment for
one or multiple presenting problems that makes a referral to the
MHC/BHIP clinic unnecessary.
VIP bootcamp is a group program with effective treatment for 3
of pcmhi’s most common presenting problems using 3 sequential 4session modules to address commonly interrelated areas of sleep,
chronic pain and stress, depression, anxiety. VIP Bootcamp
programs are currently running at facilities throughout VISN 9,
and will expand in the near future to other VISN locations.
The goal of the satisfaction survey is to better understand what
aspects of VIP Bootcamp are most helpful for veterans and how we
can continue to improve bootcamp based on their feedback. It
will also help us identify which groups of veterans (based on
age and location) are benefitting the most from different
aspects of the program.
TYPE OF ACTIVITY: (Check one)
[ ] Customer Research (Interview, Focus Groups)
[ x] Customer Feedback Survey
[ ] User Testing
ACTIVITY DETAILS
1. How will you collect the information? (Check all that apply)
[ x] Web-based or other forms of Social Media
[ ] Telephone
[ ] In-person
[ ] Mail
[ ] Other, Email, invitation based
2. Who will you collect the information from?

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VIP Bootcamp programs are currently running at facilities
throughout VISN 9, and future VISN locations, and survey links
and QR codes will be shared with attendees either through
email or in person at the completion of the 12 class program.
Survey will be anonymous.
3. How will you ask a respondent to provide this information?
Survey links and QR codes will be shared with attendees either
through email or in person on a piece of paper after the
completion of the 12 class program. Surveys will be anonymous.
4. What will the activity look like?
The survey will be offered to the attendee by VA staff through a
provided link or QR code, either through an email or a paper
handout. The attendee can fill out the survey for VIP Bootcamp
program at their convenience. The attendee can choose to use a
personal device through a url link or QR code provided. The url
or QR code will be provided on a sheet of paper for those who
prefer to complete the survey themselves on their own device
at a later date.

5. Please provide your question list.
See attached.
6. When will the activity happen?
This will be ongoing at the completion of the VIP Bootcamp at
one of the VISN locations.
7. Is an incentive (e.g., money or reimbursement of expenses,
token of appreciation) provided to participants?
[ ] Yes [ X ] No
If Yes, describe:

BURDEN HOURS
Category of Respondent

No. of
Respondents
2400

Individuals and households

Totals

2

Participation
Time
3 minutes

Burden
Hours
120
hours

CERTIFICATION:
I certify the following to be true:
1. The collections are voluntary;
2. The collections are low-burden for respondents (based on
considerations of total burden hours or burden-hours per
respondent) and are low-cost for both the respondents and the
Federal Government;
3. The collections are non-controversial and do not raise issues
of concern to other Federal agencies;
4. Any collection is targeted to the solicitation of opinions
from respondents who have experience with the program or may
have experience with the program in the near future;
5. Personally identifiable information (PII) is collected only to
the extent necessary and is not retained;
6. Information gathered is intended to be used for general
service improvement and program management purposes; and,
7. Information gathered will only be shared publicly in the
manner described in the umbrella clearance of this control
number.
Name: Brian Brown, Enterprise Measurement Project Manager, Veterans Experience Office,
VA 202.664.2924

All instruments used to collect information must include:
OMB Control No. 2900-0876
Expiration Date: 02/28/2026

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HELP SHEET
(OMB Control Number: XXXX-XXXX)
TITLE OF INFORMATION COLLECTION: Provide the name of the collection that is
the subject of the request. (e.g. Comment card for soliciting feedback on
xxxx)
PURPOSE: Provide a brief description of the purpose of this collection and
how it will be used. If this is part of a larger study or effort, please
include this in your explanation.
TYPE OF COLLECTION: Check one box. If you are requesting approval of other
instruments under the generic, you must complete a form for each instrument.
CERTIFICATION: Please read the certification carefully. If you incorrectly
certify, the collection will be returned as improperly submitted or it will
be disapproved.
Personally Identifiable Information: Agencies should only collect PII to the
extent necessary, and they should only retain PII for the period of time that
is necessary to achieve a specific objective.
BURDEN HOURS:
Category of Respondents: Identify who you expect the respondents to be in
terms of the following categories: (1) Individuals or Households;(2) Private
Sector; (3) State, local, or tribal governments; or (4) Federal Government.
Only one type of respondent can be selected per row.
No. of Respondents: Provide an estimate of the Number of respondents.
Participation Time: Provide an estimate of the amount of time required for a
respondent to participate (e.g. fill out a survey or participate in a focus
group)
Burden: Provide the Annual burden hours: Multiply the Number of responses
and the participation time and divide by 60.

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