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

Department of Veterans Affairs

OMB 2900-0770
Estimated Burden: 5 min.

OMB 2900-0770
Estimated Burden: 5 minutes

Expiration Date: XX/XX/XXXX

Department of Veterans Affairs

Veteran Appointment Mobile Application Satisfaction Survey

THE PAPERWORK REDUCTION ACT OF 1995 requires us to notify you that this information collected is in accordance with the clearance requirements of section 3507 of this Act. The public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. No person will be penalized for failing to furnish this information if it does not display a currently valid OMB control number. Your obligation to respond to this survey is voluntary and failure to furnish this information will have no effect on any of your benefits.

Performance Measure #1.3 – Veteran Satisfaction with Appointment Management

In comparison to your previous experience requesting appointments with the VA, please rate your satisfaction with the ability to request appointments using either your mobile device or desktop computer.

Ease of Use

	Strongly Agree	Agree	Neither Agree nor Disagree	Disagree	Strongly Disagree	Not Applicable
The application is intuitive and easy to use.
I was able to get my appointment(s) when needed.

Experience

Please rate your satisfaction with the following aspects of the new appointment request application

	Very Satisfied	Satisfied	Neither Satisfied nor Dissatisfied	Dissatisfied	Very Dissatisfied	Not Applicable
Being able to communicate with VA scheduling staff through the mobile device/internet browser
The responsiveness of VA scheduling staff
Having the option to request different types of appointments (e.g., In person, Phone, Video Conference)
Ability to create new appointment request(s)
Ability to see updates on my request status
Ability to view future VA appointments

Overall Satisfaction with Appointment Management

	Very Satisfied	Satisfied	Neither Satisfied nor Dissatisfied	Dissatisfied	Very Dissatisfied	Not Applicable
Overall, how satisfied are you with the appointment request application?

Performance Measure #3.2 – Perception of Application Impact to Care Coordination

Perception of Application Impact to Care Coordination

	Strongly Agree	Agree	Neither Agree nor Disagree	Disagree	Strongly Disagree	Not Applicable
Compared to the previous process, the appointment request application has improved my ability to schedule my appointments.
Compared to the previous process, the appointment request application has improved my ability to manage my appointments.
I like the fact that the VA is providing new tools to enhance my ability to schedule VA appointments.
I would recommend this application to other Veterans.
Please provide any additional comments regarding your experience with the application.	Free Response

OMB 2900-0770

10-10057

VA Form
MAR 2013