VHA ALS Customer Experience Survey

Clearance for A-11 Section 280 Improving Customer Experience Information Collection

Documents and Forms

Document Name Document Type
Wireframe Template ALS (Final).docx Other-Survey Instrument
Wireframe Template ALS (Final).docx Other-Survey Instrument
ICR Template_A11 Section 280 Clearance - ALS.docx ICR Template Section 280 VHA ALS IC Document
ICR Template_A11 Section 280 Clearance - ALS.docx ICR Template Section 280 VHA ALS IC Document

Information Collection (IC) Details

IC Title:	VHA ALS Customer Experience Survey	Agency IC Tracking Number:

IC Status: Unchanged

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
Other-Survey Instrument			Wireframe Template ALS (Final).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: Veterans, Dependents, and Veteran Beneficiaries	FR Citation: 86 FR 6992

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
ICR Template Section 280 VHA ALS	ICR Template_A11 Section 280 Clearance - ALS.docx	11/26/2024

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