OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

PACT: VA Form 10-10130 From War To Home - Audience Feedback Questionnaire

ICR 201409-2900-002 · OMB 2900-0839 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 10-10130 From War To Home Audience Feedback Questionnaire VA Form 10-10130 Form and Instruction New Available
Supporting Statement S1 10-10130 VISN 4 Audience Feedback Questionnaire 090315.docx Supporting Statement A Uploaded 2015-09-03 Available
IC Document Collections
IC IDCollectionTypeStatusForm
212912 From War To Home Audience Feedback Questionnaire VA Form 10-10130 Form and Instruction New
ICR Details
2900-0839 201409-2900-002
Historical Active
VA VHA
PACT: VA Form 10-10130 From War To Home - Audience Feedback Questionnaire
Existing collection in use without an OMB Control Number   No
Regular
Approved without change 11/09/2015
Retrieve Notice of Action (NOA) 09/04/2015
  Inventory as of this Action Requested Previously Approved
11/30/2018 36 Months From Approved
1,000 0 0
83 0 0
0 0 0
This project is being conducted under the auspices of the VISN 4 Demonstration Lab, which was funded by Patient Care Services to assess the Patient Aligned Care Team (PACT) model of care for Veterans. There is considerable interest in and urgency to implement the PACT model – reflecting both a desire to improve health care for Veterans and to sustain the VA's leadership in health care quality. CEPACT aims to contribute to these goals by evaluating the effects of the VA PACT initiative and by testing new, innovative strategies for patient care that can be spread if proven effective. This study builds on a prior photo voice study conducted by the study PI (Dr. True) in collaboration with 29 OEF/OIF Veterans, who used photos and stories to convey their post-deployment experiences, perspectives, and needs. The project aims to enhance PACT implementation by providing education about the needs and experiences of OEF/OIF Veterans that is emotionally resonant and engaging to learners on a visceral level, as well as promoting a greater sense of alignment with VA's mission of providing patient-centered care.
None
None
Not associated with rulemaking
  80 FR 4336 01/27/2015
80 FR 46107 08/03/2015
No
1
IC Title Form No. Form Name
From War To Home Audience Feedback Questionnaire VA Form 10-10130 10-10130 VISN 4 Audience Feedback Questionnaire
  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 1,000 0 0 1,000 0 0
Annual Time Burden (Hours) 83 0 0 83 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new collection therefore all burden is an increase.
$0
No
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.
09/04/2015