Nation-wide Customer Satisfaction Surveys

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0712 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 10-1465-3 Nation-wide Customer Satisfaction Surveys Form and Instruction
VA Form 10-1465-3 SHEP Outpatient Long Form 10-1465-3 VA Form 10-1465-3 update.pdf Form and Instruction
VA Form 10-1465-4 SHEP Outpatient Short Form 10-1465-4 VA Form 10-1465-4 update.pdf Form and Instruction
VA Form 10-1465-2 HCAHPS SHEP Core Short Form 10-1465-2 VA Form 10-1465-2.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Nation-wide Customer Satisfaction Surveys	Agency IC Tracking Number:	2900-0712

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	Available Electronically?	Electronic Capability
Form and Instruction	VA Form 10-1465-3	SHEP Outpatient Long Form 10-1465-3	VA Form 10-1465-3 update.pdf	No	Paper Only
Form and Instruction	VA Form 10-1465-4	SHEP Outpatient Short Form 10-1465-4	VA Form 10-1465-4 update.pdf	No	Paper Only
Form and Instruction	VA Form 10-1465-2	HCAHPS SHEP Core Short Form 10-1465-2	VA Form 10-1465-2.pdf	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 301,244	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	301,244	0	301,244
Annual IC Time Burden (Hours)	96,125	-625	96,750
Annual IC Cost Burden (Dollars)	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.