2018 005 VA MOVE! Patient Experience Survey 2018

American Customer Satisfaction Index "Customer Satisfaction Surveys"

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0007 can be found here:

Documents and Forms

Document Name Document Type
Form 005-20321 A0 2018 005 VA MOVE! Patient Experience Survey 2018 Form and Instruction
005-20321 A0 VA MOVE! Patient Experience Survey-005-20321 A0 VA MOVE! Patient Experience Survey_FINAL_IA 20321.docx Form and Instruction
1090-0007 Generic Clearance Request Form VA MOVE_IA 20321 A0-.pdf 2018 005 VA MOVE! Patient Experience Survey 2018 IC Document
OMB Mapping VA MOVE Patient Experience Survey 20321 A0.xlsx 2018 005 VA MOVE! Patient Experience Survey 2018 IC Document

Information Collection (IC) Details

IC Title:	2018 005 VA MOVE! Patient Experience Survey 2018	Agency IC Tracking Number:	005-20321 A0

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	005-20321 A0	VA MOVE! Patient Experience Survey-005-20321 A0	VA MOVE! Patient Experience Survey_FINAL_IA 20321.docx		Yes	Yes	Fillable Printable

Line of Business: General Government

Subfunction: Central Records & Statistical Mgt

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	250	250
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
2018 005 VA MOVE! Patient Experience Survey 2018	1090-0007 Generic Clearance Request Form VA MOVE_IA 20321 A0-.pdf	10/03/2018
2018 005 VA MOVE! Patient Experience Survey 2018	OMB Mapping VA MOVE Patient Experience Survey 20321 A0.xlsx	10/03/2018

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