Health Eligibility Center (HEC) Correspondence Satisfaction Letter and Customer Modality Survey

Forms and Documents

Document Name	Status
Form VA Form 10-0151 Health Eligibility Center (HEC) Correspondence Satisfaction Letter and Customer Modality Survey Form	Modified
Justification A_VHA CBO Modality Survey (v2).docx Supporting Statement A	2013-09-17
Justification B_VHA CBO Modality survey.docx Supporting Statement B	2013-08-19
Correspondence Letter.docx Supplementary Document	2013-08-19

IC Document Collections

IC ID	Document Title	Status
189770	Health Eligibility Center (HEC) Correspondence Satisfaction Letter and Customer Modality Survey Form	Modified

ICR Details

OMB Control No: 2900-0761	ICR Reference No: 201308-2900-012
Status: Historical Active	Previous ICR Reference No: 201007-2900-004
Agency/Subagency: VA	Agency Tracking No:
Title: Health Eligibility Center (HEC) Correspondence Satisfaction Letter and Customer Modality Survey
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/23/2014
	Date Received in OIRA: 01/24/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2017	36 Months From Approved	05/31/2014
Responses	383,301	0	383,301
Time Burden (Hours)	94,678	0	94,678
Cost Burden (Dollars)	0	0	0

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Abstract: The HEC goal is to respond to Veterans correspondence, addressing their concerns in a concise and understandable manner. The correspondence survey will allow Veterans an opportunity to provide anonymous feedback on how well the HEC addressed their letter. HEC will use this feedback to improve the correspondence processes. The goal of the Customer Modality Survey is to implement a survey process that allows the organization to be proactive in caring for Veterans prior to them receiving services. The survey would focus on how employees assess the needs of the patient and outline internal processes to improve services prior to the veteran receiving care.

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Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 179	09/16/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 2754	01/15/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Health Eligibility Center (HEC) Correspondence Satisfaction Letter and Customer Modality Survey	VA Form 10-0151, VA Form 10-211007	Customer Modality Administrative Survey ,   HEC Online Survey

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	383,301	383,301	0	0	0	0
Annual Time Burden (Hours)	94,678	94,678	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $65,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/24/2014

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