Information Collection

Customer Satisfaction Survey for Nutrition and Food Service

IC 44124 under ICR 201207-2900-007 · OMB 2900-0227.

Documents and Forms

Document Name Document Type
Form VA Form 10-5387 Customer Satisfaction Survey for Nutrition and Food Service Form
VA Form 10-5387 Customer Satisfaction Survey for Nutrition and Food Serv vha-10-5387.pdf vaww.va.gov/vaforms/medical/pdf/vha-10-5387.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Customer Satisfaction Survey for Nutrition and Food Service	Agency IC Tracking Number:	2900-0227

Is this a Common Form? No		IC Status: Unchanged

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 10-5387	Customer Satisfaction Survey for Nutrition and Food Service	vha-10-5387.pdf	http://vaww.va.gov/vaforms/medical/pdf/vha-10-5387.pdf	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 31,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Previously Approved
Annual Number of Responses for this IC	125,600	125,600
Annual IC Time Burden (Hours)	4,187	4,187
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.