Nation-wide Customer Satisfaction Surveys (Survey of Healthcare Experiences of Patients (SHEP)

ICR 201710-2900-010

OMB: 2900-0712

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2018-01-17
Supplementary Document
2018-01-17
Justification for No Material/Nonsubstantive Change
2016-06-22
Supporting Statement A
2017-11-08
Supporting Statement B
2017-10-25
IC Document Collections
ICR Details
2900-0712 201710-2900-010
Active 201605-2900-004
VA 2900-0712
Nation-wide Customer Satisfaction Surveys (Survey of Healthcare Experiences of Patients (SHEP)
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 03/28/2018
Retrieve Notice of Action (NOA) 01/24/2018
  Inventory as of this Action Requested Previously Approved
03/31/2021 36 Months From Approved
794,400 0 0
176,640 0 0
0 0 0

The overall purpose of the VHA Office of Quality and Performance Survey of Health Experience of Patients (SHEP) Survey Program is to systematically obtain information from patients that can be used to identify problems or complaints that need attention and to improve the quality of health care services delivered to Veterans. Information obtained from the SHEP Program is one component of a larger Network Directors Performance Agreement system in VHA that culminates in the annual Network Performance Report. Results of each of the customer satisfaction surveys are made readily available to VA Central Office (VACO), Veterans Integrated Service Network (VISN), VHA field staff, and stakeholders as part of the Network Performance Report and via the VA Intranet. Data is used to demonstrate that VA is providing timely, high quality health care services to patients and to measure improvement toward the goal of matching or exceeding the non-VA external benchmark performance.

EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
  
None

Not associated with rulemaking

  82 FR 50488 10/31/2017
83 FR 2494 01/17/2018
No

1
IC Title Form No. Form Name
Nation-wide Customer Satisfaction Surveys VA Form 10-1465-2, VA Form 10-1465-1, VA Form 10-1465-3, VA Form 10-1465-7, VA Form 10-1465-4, VA Form 10-1465-5, VA Form 10-1465-6, VA Form 10-1465-8, VA Form 10-1465-10, VA Form 10-1463-9 SHEP InPatient Long Form 10-1465-1 ,   SHEP InPatient Short Form 10-1465-2 ,   SHEP OutPatient Long Form 10-1465-3 ,   SHEP OutPatient Short Form 10-1465-4 ,   SHEP Patient Centered Medical Homes (PCMH) Short Form 10-1465-5 ,   SHEP Patient Centered Medical Homes (PCMH) Long Form 10-1465-6 ,   SHEP Home Healthcare CAHPS Long Form 10-1465-7 ,   SHEP In-Center Hemodialysis (ICHemo) Long Form 10-1465-8 ,   SHEP_SC Survey_10-1465-9 ,   SHEP VA Community Care_10-1465-10

  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 794,400 0 0 283,400 0 511,000
Annual Time Burden (Hours) 176,640 0 0 71,740 0 104,900
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
VHA has added several forms that may be required by VHA leadership in the near future, and are included here. The program change is due to the inclusion of VA Forms 10-1465-9 and 10-1465-10. In an effort to ask better, more pertinent questions of our patients, VA would like to conduct veteran outreach, focus groups, conduct cognitive testing, and other similar qualitative data collection approaches to better understand emerging patient issues and to ensure the relevancy of the questions asked in the SHEP program.

$12,500,000
Yes Part B of Supporting Statement
    No
    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.
01/24/2018


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