OMB
.report
Search
IOM Study, NCL Patient Satisfaction Survey, Battlecreek Urgent Care Survey, Tobacco & Nicotine Use Survey, VISN 1 Patient Satisfaction Survey
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NCA, VBA, VHA)
OMB: 2900-0770
IC ID: 213756
OMB.report
VA
OMB 2900-0770
ICR 201403-2900-007
IC 213756
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0770 can be found here:
2023-10-05 - Revision of a currently approved collection
2020-09-29 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Form 10-10128
IOM Study, NCL Patient Satisfaction Survey, Battlecreek Urgent Care Survey, Tobacco & Nicotine Use Survey, VISN 1 Patient Satisfaction Survey
Form and Instruction
10-10128 IOM VA Mental Health Services Evaluation
09-IOM VA MH Services Eval Non-VA Service Users Discussion Protocol 10-01-14-1.docx
Form and Instruction
10-10130 IOM VA Mental Health Services Evaluation
10-IOM VA MH Services Eval Fam Friends Non-VA Service Users Discussion Protocol 10-01-14.docx
Form and Instruction
10-10131 IOM VA Mental Health Services Evaluation
12-IOM VA MH Services Eval Non-VA Clinical Staff Discussion Protocol 10-03-14.docx
Form and Instruction
10-10133 VISN 1 Patient Satisfaction Survey
NCL Patient Satisfaction Questionnaire 6- 2011 final approved by OMB-1.docx
Form and Instruction
10-10135 Battlecreek Urgent Care Survey
Battlecreek Urgent Care Survey.docx
Form and Instruction
10-10136 Tobacco and Smoking Cessation Survey
smoking cessation.docx
Form and Instruction
IOM Discussion Groups_VA Generic Fast-Track Clearance Request_2014-11-04.docx
IOM Generic Clearance Request
IC Document
Generic_Clearance_Submission_Template_Endo-WHAV.docx
Patient Satisfaction Questionaire Generic Clearance
IC Document
VA Generic Fast-Track Clearance Request Template_20131216.docx
Smoking and Nicotine Use Generic Clearance
IC Document
VA Generic Fast-Track Clearance Request Urgent Care.docx
Battle Creek Urgent Care Generic Clearance
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
IOM Study, NCL Patient Satisfaction Survey, Battlecreek Urgent Care Survey, Tobacco & Nicotine Use Survey, VISN 1 Patient Satisfaction Survey
Agency IC Tracking Number:
2900-0770
IC Status:
New
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 and Instruction
10-10128
IOM VA Mental Health Services Evaluation
09-IOM VA MH Services Eval Non-VA Service Users Discussion Protocol 10-01-14-1.docx
No
Fillable Printable
Form and Instruction
10-10130
IOM VA Mental Health Services Evaluation
10-IOM VA MH Services Eval Fam Friends Non-VA Service Users Discussion Protocol 10-01-14.docx
No
Fillable Printable
Form and Instruction
10-10131
IOM VA Mental Health Services Evaluation
12-IOM VA MH Services Eval Non-VA Clinical Staff Discussion Protocol 10-03-14.docx
No
Fillable Printable
Form and Instruction
10-10133
VISN 1 Patient Satisfaction Survey
NCL Patient Satisfaction Questionnaire 6- 2011 final approved by OMB-1.docx
No
Fillable Printable
Form and Instruction
10-10135
Battlecreek Urgent Care Survey
Battlecreek Urgent Care Survey.docx
No
Fillable Printable
Form and Instruction
10-10136
Tobacco and Smoking Cessation Survey
smoking cessation.docx
No
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2,990
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
2,990
0
2,990
0
0
0
Annual IC Time Burden (Hours)
897
0
897
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
IOM Generic Clearance Request
IOM Discussion Groups_VA Generic Fast-Track Clearance Request_2014-11-04.docx
11/06/2014
Patient Satisfaction Questionaire Generic Clearance
Generic_Clearance_Submission_Template_Endo-WHAV.docx
11/06/2014
Smoking and Nicotine Use Generic Clearance
VA Generic Fast-Track Clearance Request Template_20131216.docx
11/06/2014
Battle Creek Urgent Care Generic Clearance
VA Generic Fast-Track Clearance Request Urgent Care.docx
11/06/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.