Community Living Center (CLC) Satisfaction Survey; Cardiac Cath Lab Satisfaction Survey; Psychiatric Patient Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA, VBA, VHA)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0770 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 10-0548 Community Living Center (CLC) Satisfaction Survey; Cardiac Cath Lab Satisfaction Survey; Psychiatric Patient Survey Form
VA Form 10-0548 Community Living Center (CLC) Satisfaction Survey CLC Resident Survey 10-0548.docx Form
VA Form 10-0547 Cardiac Cath Lab Customer Satisfaction Survey Cath Lab Satisfaction Survey 10-0547 (2).docx Form
VA Form 10-0550 Psychiatric Patient Satisfaction Survey Psychiatric Patient Satisfaction Survey 10-0550.pdf Form
Generic Request Community Center Patient Survey .docx Community Livinig (CLC) Satisfaction Survey IC Document
Generic Request_Cardiac Cath Lab Survey.docx Cardiac Cath Lab Customer Satisfaction Survey IC Document
Generic Request_Psychiatric Patient Satisfaction Survey.docx Psychiatric Patient Satisfaction Survey IC Document

Information Collection (IC) Details

IC Title:	Community Living Center (CLC) Satisfaction Survey; Cardiac Cath Lab Satisfaction Survey; Psychiatric Patient Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.8(d)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Electronic Capability
Form	VA Form 10-0548	Community Living Center (CLC) Satisfaction Survey	CLC Resident Survey 10-0548.docx	No	Paper Only
Form	VA Form 10-0547	Cardiac Cath Lab Customer Satisfaction Survey	Cath Lab Satisfaction Survey 10-0547 (2).docx	No	Paper Only
Form	VA Form 10-0550	Psychiatric Patient Satisfaction Survey	Psychiatric Patient Satisfaction Survey 10-0550.pdf	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 875	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	875	875
Annual IC Time Burden (Hours)	64	64
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Community Livinig (CLC) Satisfaction Survey	Generic Request Community Center Patient Survey .docx	05/15/2012
Cardiac Cath Lab Customer Satisfaction Survey	Generic Request_Cardiac Cath Lab Survey.docx	05/14/2012
Psychiatric Patient Satisfaction Survey	Generic Request_Psychiatric Patient Satisfaction Survey.docx	05/14/2012

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