Childcare Service Satisfaction Survey; Purchased Care Online Survey; VHA ORD Focus Group Request; Teleretinal Patient Satisfaction Survey; Spinal Cord Home Care Satisfaction Survey

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⚠️ Notice: This information collection may be referencing outdated material.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 VA Form 10-0531 Childcare Service Satisfaction Survey; Purchased Care Online Survey; VHA ORD Focus Group Request; Teleretinal Patient Satisfaction Survey; Spinal Cord Home Care Satisfaction Survey Form
VHA_ORD_Focus Group Moderators Guide_2_2012.doc Other-Moderator Script
VHA ORD Focus Group Participant Screener 3_2012.doc Telephonic Screening Call Other-Participant screener script
VA Form 10-0531 Childcare Services Satisfaction Survey Childcare Services Satisfaction Survey 10-0531.DOCX Form
VA Form 10-0538 Purchased Care Patient Satisfaction Survey Purchased Care Patient Satisfaction Survey_10-0538.docx URL To Be Determined Form
VA Form 10-0540 Teleretinal Patient Satisfaction Survey TeleRetinal Patient Survey_10-0540.pdf Form
VA Form 10-0542 Spinal Cord Home Care Survey Spinal Cord Home Care Survey 10-0542.doc Form
Childcare Generic_Clearance_Submission.docx Childcare Generic_Clearance_Submission IC Document
Purchased Care Online Survey_Generic Request(v4).docx Purchased Care Online Survey_Generic Request IC Document
Teleretinal_Generic_Clearance_Submission.docx Teleretinal_Generic_Clearance_Submission IC Document
Spinal Cord home Care Survey Generic_Request.docx Spinal Cord home Care Survey Generic_Request IC Document
VHA ORD Generic Clearance_Request__3_7_2012.doc Focus Groups Soliciting feedback on VA Research Communication IC Document
VA ORD_Informed_Consent_Form (4).docx ORD Informed Consent IC Document

Information Collection (IC) Details

IC Title:	Childcare Service Satisfaction Survey; Purchased Care Online Survey; VHA ORD Focus Group Request; Teleretinal Patient Satisfaction Survey; Spinal Cord Home Care Satisfaction Survey	Agency IC Tracking Number:

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	VA Form 10-0531	Childcare Services Satisfaction Survey	Childcare Services Satisfaction Survey 10-0531.DOCX		No		Paper Only
Form	VA Form 10-0538	Purchased Care Patient Satisfaction Survey	Purchased Care Patient Satisfaction Survey_10-0538.docx	URL To Be Determined	Yes	Yes	Fillable Fileable
Form	VA Form 10-0540	Teleretinal Patient Satisfaction Survey	TeleRetinal Patient Survey_10-0540.pdf		No		Paper Only
Form	VA Form 10-0542	Spinal Cord Home Care Survey	Spinal Cord Home Care Survey 10-0542.doc		No		Paper Only
Other-Moderator Script			VHA_ORD_Focus Group Moderators Guide_2_2012.doc		No		Paper Only
Other-Participant screener script			VHA ORD Focus Group Participant Screener 3_2012.doc	Telephonic Screening Call	No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30,875	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	30,875	30,875
Annual IC Time Burden (Hours)	1,883	1,883
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Childcare Generic_Clearance_Submission	Childcare Generic_Clearance_Submission.docx	01/27/2012
Purchased Care Online Survey_Generic Request	Purchased Care Online Survey_Generic Request(v4).docx	02/17/2012
Teleretinal_Generic_Clearance_Submission	Teleretinal_Generic_Clearance_Submission.docx	01/27/2012
Spinal Cord home Care Survey Generic_Request	Spinal Cord home Care Survey Generic_Request.docx	01/27/2012
Focus Groups Soliciting feedback on VA Research Communication	VHA ORD Generic Clearance_Request__3_7_2012.doc	03/07/2012
ORD Informed Consent	VA ORD_Informed_Consent_Form (4).docx	02/27/2012

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