OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Survey of Healthcare Experiences Dental Patient Satisfaction Survey

ICR 201507-2900-004 · OMB 2900-0764 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 10-10070 Survey of Healthcare Experiences of Patients, Dental Patient Satisfaction Survey Form and Instruction Modified Available
2900-0764 - SS - 101915.doc Supporting Statement A Uploaded 2015-10-19 Available
Memo on form number change.doc Supplementary Document Uploaded 2013-08-20 Available
Post SurveyThank You letter.doc Supplementary Document Uploaded 2010-07-06 Available
Pre-Survey Letter.doc Supplementary Document Uploaded 2010-07-06 Repair queued
2900-0764_Justification B scb update.docx Supporting Statement B Uploaded 2015-09-08 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
192326 Survey of Healthcare Experiences of Patients, Dental Patient Satisfaction Survey Form and Instruction Modified
ICR Details
2900-0764 201507-2900-004
Historical Active 201308-2900-034
VA 2900-0764
Survey of Healthcare Experiences Dental Patient Satisfaction Survey
Revision of a currently approved collection   No
Regular
Approved without change 02/05/2016
Retrieve Notice of Action (NOA) 10/30/2015
  Inventory as of this Action Requested Previously Approved
02/28/2019 36 Months From Approved 04/30/2017
36,585 0 36,585
9,146 0 9,146
0 0 0
The overall purpose of the VHA Office of Dentistry Dental Patient Satisfaction Survey is to systematically obtain information from patients that can be used to identify problems or complaints that need attention and to improve the quality of dental health care services delivered to Veterans. The Office of Dentistry (OOD) currently tracks a number of clinical parameters indicative of quality care (e.g., appropriate use of fluoride products in high caries risk patients, frequency of dental examinations and care provided to medically compelling patients); however, patient satisfaction with this care is not specifically measured. The mission of the Veterans Health Administration (VHA) is to provide high quality medical and dental care to eligible veterans.
EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
  
None
Not associated with rulemaking
  80 FR 46103 08/03/2015
80 FR 55178 09/14/2015
No
  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 36,585 36,585 0 0 0 0
Annual Time Burden (Hours) 9,146 9,146 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$300,000
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.
10/30/2015