Information Collection

Survey of Healthcare Experiences of Patients, Dental Patient Satisfaction Survey

IC 192326 under ICR 201003-2900-014 · OMB 2900-0764.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0764 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 10-0503 Survey of Healthcare Experiences of Patients, Dental Patient Satisfaction Survey Form and Instruction
VA Form 10-0503 Survey of Healthcare Experiences of Patients, Dental Pat Dental Survey 10-0503 final.pdf To Be Determined by Contractor Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Survey of Healthcare Experiences of Patients, Dental Patient Satisfaction Survey	Agency IC Tracking Number:

Is this a Common Form? No		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	VA Form 10-0503	Survey of Healthcare Experiences of Patients, Dental Patient Satisfaction Survey	Dental Survey 10-0503 final.pdf	To Be Determined by Contractor	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 36,585	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	36,585	36,585
Annual IC Time Burden (Hours)	9,146	9,146
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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