OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Health Eligibility Center (HEC) Correspondence Satisfaction Letter and Customer Modality Survey

ICR 201308-2900-012 · OMB 2900-0761 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form VA Form 10-0151 Health Eligibility Center (HEC) Correspondence Satisfaction Letter and Customer Modality Survey Form Modified Available
Justification A_VHA CBO Modality Survey (v2).docx Supporting Statement A Uploaded 2013-09-17 Available
Justification B_VHA CBO Modality survey.docx Supporting Statement B Uploaded 2013-08-19 Available
Correspondence Letter.docx Supplementary Document Uploaded 2013-08-19 Available
IC Document Collections
IC IDCollectionTypeStatusForm
189770 Health Eligibility Center (HEC) Correspondence Satisfaction Letter and Customer Modality Survey Form Modified
ICR Details
2900-0761 201308-2900-012
Historical Active 201007-2900-004
VA
Health Eligibility Center (HEC) Correspondence Satisfaction Letter and Customer Modality Survey
Extension without change of a currently approved collection   No
Regular
Approved without change 05/23/2014
Retrieve Notice of Action (NOA) 01/24/2014
  Inventory as of this Action Requested Previously Approved
05/31/2017 36 Months From Approved 05/31/2014
383,301 0 383,301
94,678 0 94,678
0 0 0
The HEC goal is to respond to Veterans correspondence, addressing their concerns in a concise and understandable manner. The correspondence survey will allow Veterans an opportunity to provide anonymous feedback on how well the HEC addressed their letter. HEC will use this feedback to improve the correspondence processes. The goal of the Customer Modality Survey is to implement a survey process that allows the organization to be proactive in caring for Veterans prior to them receiving services. The survey would focus on how employees assess the needs of the patient and outline internal processes to improve services prior to the veteran receiving care.
EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
  
None
Not associated with rulemaking
  78 FR 179 09/16/2013
79 FR 2754 01/15/2014
No
1
IC Title Form No. Form Name
Health Eligibility Center (HEC) Correspondence Satisfaction Letter and Customer Modality Survey VA Form 10-0151, VA Form 10-211007 Customer Modality Administrative Survey ,   HEC Online Survey
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 383,301 383,301 0 0 0 0
Annual Time Burden (Hours) 94,678 94,678 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$65,000
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Crystal Rennie 202 632-7492 [email protected]
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/24/2014