Vet Apptmnt Apps Satisfaction Srvy/Hem-Oncology Telehealth Satisfaction Svy

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⚠️ Notice: This information collection may be referencing outdated material.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
Vet Appt Mobile App Survey Form_10-10057.docx Web App URL TBD Other-Mobile application
Hem-Oncology Telehealth Satisfaction Survey_10-10054 .doc TBD - Telemedicine Equipment Other-Web-based
Procedure Script for Hem-Oncology Satisfaction Survey.docx Instruction
Generic_Request_ Appointment Mobile App Survey.docx Veteran Appointment Mobile Application Satisfaction Survey request IC Document
Hem-Oncology Telehealth Generic_Clearance_Submission.docx Patient Satisfaction Svy-Telemedicine/Hem Oncology Services IC Document

Information Collection (IC) Details

IC Title:	Vet Apptmnt Apps Satisfaction Srvy/Hem-Oncology Telehealth Satisfaction Svy	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Mobile application	Vet Appt Mobile App Survey Form_10-10057.docx	Web App URL TBD	Yes	Yes	Fillable Fileable
Other-Web-based	Hem-Oncology Telehealth Satisfaction Survey_10-10054 .doc	TBD - Telemedicine Equipment	Yes	Yes	Fillable Fileable
Instruction	Procedure Script for Hem-Oncology Satisfaction Survey.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 430	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	430	430
Annual IC Time Burden (Hours)	36	36
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Veteran Appointment Mobile Application Satisfaction Survey request	Generic_Request_ Appointment Mobile App Survey.docx	03/22/2013
Patient Satisfaction Svy-Telemedicine/Hem Oncology Services	Hem-Oncology Telehealth Generic_Clearance_Submission.docx	03/22/2013

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