uSPEQ® Consumer Experience Survey (Rehabilitation)

ICR 201703-2900-002

OMB: 2900-0752

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Unchanged
Supplementary Document
2016-11-30
Supporting Statement A
2017-03-14
Supporting Statement B
2017-03-14
Supplementary Document
2009-01-27
IC Document Collections
IC ID
Document
Title
Status
187874 Unchanged
ICR Details
2900-0752 201703-2900-002
Historical Active 201611-2900-012
VA
uSPEQ® Consumer Experience Survey (Rehabilitation)
Extension without change of a currently approved collection   No
Regular
Approved without change 06/13/2017
Retrieve Notice of Action (NOA) 03/21/2017
  Inventory as of this Action Requested Previously Approved
06/30/2020 36 Months From Approved 06/30/2017
384,000 0 384,000
32,000 0 32,000
0 0 0

The uSPEQ® is a confidential, anonymous, and scientifically-tested consumer reporting system that gives persons served a voice in their services. There is a current absence of an existing survey model that is psychometrically sound and nationally benchmarked for survey of consumer experiences in VA rehabilitation programs. VA rehabilitation programs are committed to adopting the uSPEQ® survey to assess outcome measures related to patient perceptions of and perspectives regarding rehabilitation experiences. VA recognizes that adoption of this survey provides a systems approach and benchmarking capability for patient assessed outcomes of care.

US Code: 38 USC Chapter 17 Name of Law: Hospital, Nursing Home, Domiciliary, and Medical Care
  
None

Not associated with rulemaking

  81 FR 86073 11/29/2016
82 FR 13057 03/08/2017
No

1
IC Title Form No. Form Name
uSPEQ® Consumer Experience Survey (Rehabilitation) VA Form 10-0467 uSPEQ Consumer Experience Survey (Rehabilitation)

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 384,000 384,000 0 0 0 0
Annual Time Burden (Hours) 32,000 32,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$960,000
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Cynthia Harvey - Pryor 202 461-5870 cynthia.harvey-pryor@va.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
03/21/2017


© 2024 OMB.report | Privacy Policy