Information Collection

Care Coordination Home Telehealth Patient Satisfaction Survey

IC 191713 under ICR 201512-2900-010 · OMB 2900-0766.

Documents and Forms

Document Name Document Type
Form 10-0341 Care Coordination Home Telehealth Patient Satisfaction Survey Form and Instruction
10-0341 VHA Telehealth Services HT Patient Satisfaction Survey VHA Telehealth Services HT Patient Satisfaction Survey with VE questions.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Care Coordination Home Telehealth Patient Satisfaction Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	10-0341	VHA Telehealth Services HT Patient Satisfaction Survey	VHA Telehealth Services HT Patient Satisfaction Survey with VE questions.docx		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16,400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	65,600	65,600
Annual IC Time Burden (Hours)	1,640	1,640
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.