Boston VAMC Ophthamology Satisfaction Survey / VISN 20 Telephone Call Center Satisfaction 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⚠️ Notice: This information collection may be referencing outdated material.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 10-211001N Boston VAMC Ophthamology Satisfaction Survey / VISN 20 Telephone Call Center Satisfaction Survey Form
VA Form 10-211001N Patient Satisfaction Survey_Boston VAMC_Dept. of Ophtham Patient Satisfaction Boston Survey 10-211001NR.pdf Form
VA Form 10-10059 Telephone Customer Service Experience Satisfaction Surve VISN 20 Tele Service Satisfaction Survey 10-10059.pdf Form
Generic Request-Boston VAMC Patient Satisfaction.docx Patient Survey-Boston VAMC Department of Ophthamology IC Document
Memo on resubmission of Boston VAMC generic ICR.doc Memo on resubmission of Boston VAMC generic ICR IC Document
VISN 20 Tele Call Center Svc Generic_Clearance_Request.docx VISN 20 Tele-Call Center Svc Generic_Clearance_Request IC Document

Information Collection (IC) Details

IC Title:	Boston VAMC Ophthamology Satisfaction Survey / VISN 20 Telephone Call Center Satisfaction Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 10-211001NR	Patient Satisfaction Survey_Boston VAMC_Dept. of Ophthamology	Patient Satisfaction Boston Survey 10-211001NR.pdf		No		Paper Only
Form	VA Form 10-10059	Telephone Customer Service Experience Satisfaction Survey	VISN 20 Tele Service Satisfaction Survey 10-10059.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,300	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	2,300	2,300
Annual IC Time Burden (Hours)	275	275
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Patient Survey-Boston VAMC Department of Ophthamology	Generic Request-Boston VAMC Patient Satisfaction.docx	05/09/2013
Memo on resubmission of Boston VAMC generic ICR	Memo on resubmission of Boston VAMC generic ICR.doc	05/09/2013
VISN 20 Tele-Call Center Svc Generic_Clearance_Request	VISN 20 Tele Call Center Svc Generic_Clearance_Request.docx	05/09/2013

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