Veterans Transportation Service Questionnaire

Date: January 9, 2014

To: VA OMB Desk Officer
Copy: Kerry Pugh, VHA PPRA Liaison
Re: Request to revise Generic data collection
2900-0770: Veterans Transportation Service questionnaire

The Veterans Transportation program would like to add an additional 3 part question to the Survey. This request is being made to gather information concerning the Veteran experience in the various field offices. An open text question and 2 yes/no questions concerning their experience

Additional questions:

Which medical center do you use for care? __________________________

1. Did the transportation staff offer directions to the clinic or your final destination in the facility? Yes/No/NA

2. Did the transportation staff ask if you needed further assistance once you had arrived at the facility? Yes/No/NA

The change in burden is reflected in the following table:

BURDEN HOURS

	No. of Respondents	Participation Time	Burden
Current survey	2000	6 minutes	200 hours
Current survey plus additional questions	2000	7 minutes	233 hours

FEDERAL COST: The estimated annual cost to the Federal government is $3,500.00

Vr,
Dennis W. Boyette

Health Eligibility Center