VISN 1 NCL Phlebotomy Service - Patient Satisfaction Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (VBA, VHA, NCA)

Documents and Forms

Document Name Document Type
VISN 1_NCL Patient Satisfaction Survey_final_2023.docx Other-Survey
Generic Supporting Statement_VISN 1 - NCL Patient Satisfaction Survey_updated Nov 2023.docx Generic Supporting Statement - VISN 1 NCL Phlebotomy Service - Patient Satisfaction Survey - updated Nov 2023 IC Document

Information Collection (IC) Details

IC Title:	VISN 1 NCL Phlebotomy Service - Patient Satisfaction Survey	Agency IC Tracking Number:	VHA-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
Other-Survey			VISN 1_NCL Patient Satisfaction Survey_final_2023.docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	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	2,000	2,000
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Generic Supporting Statement - VISN 1 NCL Phlebotomy Service - Patient Satisfaction Survey - updated Nov 2023	Generic Supporting Statement_VISN 1 - NCL Patient Satisfaction Survey_updated Nov 2023.docx	11/30/2023

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