Clinical Video Telehealth (CVT) Patient Satisfaction Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA, VBA, VHA)

OMB: 2900-0770

IC ID: 199625

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Form
Form
IC Document
Information Collection (IC) Details

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Clinical Video Telehealth (CVT) Patient Satisfaction Survey 2900-0770
 
Modified
 
Voluntary
 
5 CFR 1320.8(d)

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 10-0481a Clinical Video Telehealth (CVT) Patient Satisfaction Survey Clinical Video Telehealth (CVT) Patient Survey_ VA Form 10-0481a.docx No   Paper Only

Health Health Care Services

 

2,500 0
   
Individuals or Households
 
   0 %

  Requested 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 2,500 0 0 0 0 2,500
Annual IC Time Burden (Hours) 125 0 0 0 0 125
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Clinical Video Telehealth (CVT) Patient Satisfaction Survey Request_for_Generic_Clearance_Clinical_Video_Telehealth_Survey(v2)1.docx 10/17/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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