1_Spinal Cord Injury Survey__2_Non-Sub Change-Veterans Experience Access (VE Outpatient Survey) Scheduling Appointment

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⚠️ Notice: This information collection may be referencing outdated material.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 10-0515 1_Spinal Cord Injury Survey__2_Non-Sub Change-Veterans Experience Access (VE Outpatient Survey) Scheduling Appointment Form and Instruction
VEOutpatientSurvey_OMB02.26.18.pdf •Appointments - survey.voice.medallia.com/?va-trx-apt •Healthcare - survey.voice.medallia.com/?va-trx-healthcare Other-E-Survey
10-0515 Spinal Cord Injury Patient Care Survey Spinal Cord Injury Patient Care Survey.doc Form and Instruction
Generic Clearance_Spinal Cord Injury.doc Generic Request_Spinal Cord Injury IC Document
White Paper_NonSubChange OutpatientSrvy_02.20.18.docx White Paper_NonSubChange VE Outpatient Survey IC Document
2017 NOA for VEOutpatient Generic 2900-0770.pdf 2017 NOA for VE Outpatient Generic 2900-0770 Clearance IC Document
Justification_VE OutPat Appointment Scheduling SurveyJUN2017.docx Justification_VE OutPat Appointment Scheduling SurveyJUN2017 IC Document

Information Collection (IC) Details

IC Title:	1_Spinal Cord Injury Survey__2_Non-Sub Change-Veterans Experience Access (VE Outpatient Survey) Scheduling Appointment	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	10-0515	Spinal Cord Injury Patient Care Survey	Spinal Cord Injury Patient Care Survey.doc		No		Paper Only
Other-E-Survey			VEOutpatientSurvey_OMB02.26.18.pdf	•Appointments - https://survey.voice.medallia.com/?va-trx-apt •Healthcare - https://survey.voice.medallia.com/?va-trx-healthcare •Labs - https://survey.voice.medallia.com/?va-trx-lab •Pharmacy - https://survey.voice.medallia.com/?va-trx-pharmacy •Pharmacy Mail - https://survey.voice.medallia.com/?va-trx-pharmacy-mail	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 80	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	80	80
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Request_Spinal Cord Injury	Generic Clearance_Spinal Cord Injury.doc	02/14/2018
White Paper_NonSubChange VE Outpatient Survey	White Paper_NonSubChange OutpatientSrvy_02.20.18.docx	03/05/2018
2017 NOA for VE Outpatient Generic 2900-0770 Clearance	2017 NOA for VEOutpatient Generic 2900-0770.pdf	03/05/2018
Justification_VE OutPat Appointment Scheduling SurveyJUN2017	Justification_VE OutPat Appointment Scheduling SurveyJUN2017.docx	03/05/2018

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