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Federal forms, ICRs, and supporting documents

Information Collection Request

Survey of Healthcare Experiences of Patients (SHEP) -- Dental Care Patient Satisfaction Survey

ICR 202108-2900-020 · OMB 2900-0764 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 10-10070 Survey of Healthcare Experiences of Patients (SHEP) -- Dental Care Patient Satisfaction Survey Form and Instruction Modified Repair queued
30-day FRN_Dental Patient Satisfaction Survey (SHEP)_published 11152021.pdf Supplementary Document Uploaded 2021-11-16 Repair queued
60-day FRN_Dental Patient Satisfaction Survey (SHEP)_published 09032021.pdf Supplementary Document Uploaded 2021-09-03 Repair queued
Supporting Statement A _Dental Care Patient Satis Survey (SHEP)_2900-0764_final Nov 2021.docx Supporting Statement A Uploaded 2021-11-16 Repair queued
Supporting Statement B_Dental Care Patient Satis Survey (SHEP)_2900-0764_updated Oct 2021.docx Supporting Statement B Uploaded 2021-11-09 Missing upstream
IC Document Collections
IC IDCollectionTypeStatusForm
192326 Survey of Healthcare Experiences of Patients (SHEP) -- Dental Care Patient Satisfaction Survey Form and Instruction Modified
ICR Details
2900-0764 202108-2900-020
Received in OIRA 201507-2900-004
VA 2900-0764
Survey of Healthcare Experiences of Patients (SHEP) -- Dental Care Patient Satisfaction Survey
Reinstatement without change of a previously approved collection   No
Regular 11/17/2021
  Requested Previously Approved
36 Months From Approved
50,400 0
12,600 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
  86 FR 49599 09/03/2021
86 FR 63105 11/15/2021
No
  Total Request 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 50,400 0 0 13,815 0 36,585
Annual Time Burden (Hours) 12,600 0 0 3,454 0 9,146
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The burden increase is based upon program data and increase in survey distribution.
$425,821
Yes Part B of Supporting Statement
    No
    No
No
No
No
No
Frances O'Donnell 703 405-2449 [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.
11/17/2021