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VHA Pallative Care Telehealth Appointments / Mental Health Veterans Survey
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (Administrations)
OMB: 2900-0769
IC ID: 228034
OMB.report
VA
OMB 2900-0769
ICR 201404-2900-002
IC 228034
( )
Documents and Forms
Document Name
Document Type
Pallative System Usability Scale and Demographic Qs_UX Pall Care UPDATED UNION OMB.pdf
Other-Usability scale
MH Veterans Satisfaction Survey.docx
Other-Survey
Generic Clearance Submission_Telehealth Appts.doc
Veterans' and Providers' User Experience of Palliative Care Telehealth Appointments
IC Document
MH Veterans Satisfaction Generic Request_052417.docx
Office of Mental Health Veteran Satisfaction Survey
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
VHA Pallative Care Telehealth Appointments / Mental Health Veterans Survey
Agency IC Tracking Number:
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
Other-Usability scale
Pallative System Usability Scale and Demographic Qs_UX Pall Care UPDATED UNION OMB.pdf
TBD
Yes
No
Fillable Printable
Other-Survey
MH Veterans Satisfaction Survey.docx
No
Paper Only
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:
10,010
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
10,010
0
10,010
0
0
0
Annual IC Time Burden (Hours)
2,503
0
2,503
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Veterans' and Providers' User Experience of Palliative Care Telehealth Appointments
Generic Clearance Submission_Telehealth Appts.doc
08/24/2017
Office of Mental Health Veteran Satisfaction Survey
MH Veterans Satisfaction Generic Request_052417.docx
08/24/2017
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.