OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Survey of Healthcare Experiences of Patients (SHEP)

OMB 2900-0712 ยท VA.

OMB 2900-0712

The overall purpose of the VHA Office of Quality and Performance Survey of Health Experience of Patients (SHEP) Survey Program 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 health care services delivered to Veterans. Information obtained from the SHEP Program is one component of a larger Network Directors Performance Agreement system in VHA that culminates in the annual Network Performance Report. Results of each of the customer satisfaction surveys are 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. Data is used to demonstrate that VA is providing timely, high quality health care services to patients and to measure improvement toward the goal of matching or exceeding the non-VA external benchmark performance.

The latest form for Survey of Healthcare Experiences of Patients (SHEP) expires 2021-03-31 and is listed under ICR 201710-2900-010.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form VA Form 10-1465-6 SHEP PCMH Ambulatory CareLong FormForm and Instruction
Form VA Form 10-1465-4 SHEP Ambulatory Care Short FormForm and Instruction
Form VA Form10-1465-3 SHEP Ambulatory Care Long FormForm and Instruction
Form VA Form 10-1465-1 SHEP Inpatient Long FormForm and Instruction
Form VA Form 10-1465-11 SHEP Recent Visit SurveyForm and Instruction
Form VA Form 10-1465-10 SHEP VA Community CareForm and Instruction
Form VA Form 10-1465-9 SHEP Specialty Care SurveyForm and Instruction
Form VA Form 10-1465-8 SHEP In-Center Hemodialysis (ICHemo) Long FormForm and Instruction
Form VA Form 10-1465-7 SHEP Home Healthcare CAHPS Long FormForm and Instruction
Form VA Form 10-1465-5 SHEP Patient Centered Medical Homes (PCMH) Short FormForm and Instruction
Form VA Form 10-1465-2 SHEP Inpatient Short FormForm and Instruction
Form VA Form 10-1465-2 SHEP - Nationwide Customer Satisfaction SurveysForm and Instruction
30-day FRN_SHEP Surveys_published 06232021.pdf Supplementary Document
60 Day FRN - SHEP Surveys - Published 04062021.pdf Supplementary Document
Supporting Statement A_2900-0712_SHEP Surveys_final Oct 2021.docxSupporting Statement A
Supporting Statement B_2900-0712_SHEP Surveys_final Oct 2021.docxSupporting Statement B
SHEP - Nationwide Customer Satisfaction Surveys Form and Instruction
SHEP - Nationwide Customer Satisfaction Surveys Form and Instruction
SHEP - Nationwide Customer Satisfaction Surveys Form and Instruction
SHEP - Nationwide Customer Satisfaction Surveys Form and Instruction
SHEP - Nationwide Customer Satisfaction Surveys Form and Instruction
SHEP - Nationwide Customer Satisfaction Surveys Form and Instruction
SHEP - Nationwide Customer Satisfaction Surveys Form and Instruction
SHEP - Nationwide Customer Satisfaction Surveys Form and Instruction
SHEP - Nationwide Customer Satisfaction Surveys Form and Instruction
SHEP - Nationwide Customer Satisfaction Surveys Form and Instruction
SHEP - Nationwide Customer Satisfaction Surveys Form and Instruction
SHEP - Nationwide Customer Satisfaction Surveys Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202102-2900-017 Reinstatement with change of a previously approved collection 2021-11-08 Withdrawn
201710-2900-010 Reinstatement with change of a previously approved collection 2018-01-24 Approved without change
201605-2900-004 No material or nonsubstantive change to a currently approved collection 2016-06-22 Approved without change
201601-2900-013 No material or nonsubstantive change to a currently approved collection 2016-01-19 Improperly submitted and continue
201312-2900-022 Revision of a currently approved collection 2014-01-24 Approved without change
201306-2900-010 Revision of a currently approved collection 2013-07-23 Approved with change
201112-2900-017 Revision of a currently approved collection 2012-11-06 Withdrawn and continue
201001-2900-008 Revision of a currently approved collection 2010-06-10 Approved with change
200710-2900-003 New collection (Request for a new OMB Control Number) 2008-04-03 Approved with change