Patient Satisfaction Questionnaire: Network Consolidated Laboratory (NCL) Phlebotomy Service

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⚠️ Notice: This information collection may be referencing outdated material.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 10-0516 Patient Satisfaction Questionnaire: Network Consolidated Laboratory (NCL) Phlebotomy Service Form
VA Form 10-0516 Patient Satisfaction Questionnaire: Laboratory P&LMS VA NCL Patient Satisfaction Questionnaire 6- 2011.doc Form
Network_Consolidated__Lab_Generic_Clearance_Submission(v2)1.docx Patient Satisfaction Questionnaire Network Consolidated Laboratory (NCL) Phlebotomy Service IC Document

Information Collection (IC) Details

IC Title:	Patient Satisfaction Questionnaire: Network Consolidated Laboratory (NCL) Phlebotomy Service	Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 5 CFR 1320.8(d)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 10-0516	Patient Satisfaction Questionnaire: Laboratory P&LMS VA New England Healthcare System	NCL Patient Satisfaction Questionnaire 6- 2011.doc		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,600	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	1,600	1,600
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Patient Satisfaction Questionnaire Network Consolidated Laboratory (NCL) Phlebotomy Service	Network_Consolidated__Lab_Generic_Clearance_Submission(v2)1.docx	10/28/2011

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