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Care Coordination Home Telehealth Patient Satisfaction Survey
Care Coordination Home Telehealth (CCHT) Patient Satisfaction Survey
OMB: 2900-0766
IC ID: 191713
OMB.report
VA
OMB 2900-0766
ICR 201308-2900-016
IC 191713
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0766 can be found here:
2016-01-04 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 10-0341
Care Coordination Home Telehealth Patient Satisfaction Survey
Form
10-0341 Care Coordination Home Telehealth (CCHT) Patient Satisfa
Telehealth Survey VA Form 10-0481_20140314.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Care Coordination Home Telehealth Patient Satisfaction Survey
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
10-0341
Care Coordination Home Telehealth (CCHT) Patient Satisfaction Survey
Telehealth Survey VA Form 10-0481_20140314.pdf
Yes
Yes
Fillable Fileable Signable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
16,400
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
65,600
0
0
0
0
65,600
Annual IC Time Burden (Hours)
1,640
0
0
0
0
1,640
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.