[Federal Register Volume 77, Number 203 (Friday, October 19, 2012)]
[Notices]
[Pages 64382-64383]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-25748]


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DEPARTMENT OF VETERANS AFFAIRS

[OMB Control No. 2900-0712]


Agency Information Collection (Nation-Wide Customer Satisfaction 
Surveys) Activities Under OMB Review

AGENCY: Veterans Health Administration, Department of Veterans Affairs.

ACTION: Notice.

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SUMMARY: In compliance with the Paperwork Reduction Act (PRA) of 1995 
(44 U.S.C. 3501-3521), this notice announces that the Veterans Health 
Administration (VHA), Department of Veterans Affairs, will submit the 
collection of information abstracted below to the Office of Management 
and Budget (OMB) for review and comment. The PRA submission describes 
the nature of the information collection and its expected cost and 
burden and includes the actual data collection instrument.

DATES: Comments must be submitted on or before November 19, 2012.

ADDRESSES: Submit written comments on the collection of information 
through www.Regulations.gov; or to VA's OMB Desk Officer, OMB Human 
Resources and Housing Branch, New Executive Office Building, Room 
10235, Washington, DC 20503 (202) 395-7316. Please refer to ``OMB 
Control No. 2900-0712'' in any correspondence.

FOR FURTHER INFORMATION CONTACT: Crystal Rennie, Enterprise Records 
Service (005R1B), Department of Veterans Affairs, 810 Vermont Avenue 
NW., Washington, DC 20420, (202) 632-7492, fax (202) 632-7583 or email 
[email protected]. Please refer to ``OMB Control No. 2900-0712.''

SUPPLEMENTARY INFORMATION:
    Title: Nation-wide Customer Satisfaction Surveys, VA Forms 10-1465-
2 through 10-1465-6.
    OMB Control Number: 2900-0712.
    Type of Review: Revision of a previously approved collection.
    Abstract: The Survey of Health Experience of Patients (SHEP) Survey 
is used to obtain information from VA patients that will be used to 
identify problems or compliant and to improve the quality of health 
care services delivered to veterans. Data will be used to measure 
improvement toward the goal of matching or exceeding non-VA external 
benchmark performance.
    An agency may not conduct or sponsor, and a person is not required 
to respond to a collection of information unless it displays a 
currently valid OMB control number. The Federal Register

[[Page 64383]]

Notice with a 60-day comment period soliciting comments on this 
collection of information was published on January 17, 2012, at page 
2349.
    Affected Public: Individuals or households.
    Estimated Annual Burden:
    a. Inpatient Short Form, VA Form 10-1465-2--18,750 hours.
    b. Ambulatory Care Long Form, VA Form 10-1465-3--9,802 hours.
    c. Ambulatory Care Short Form, VA Form 10-1465-4--42,233 hours.
    d. Clinician and Group Survey Patient Centered Medical Home, Short 
Form, VA Form 10-1465-5--20,000 hours.
    e. Clinician and Group Survey Patient Centered Medical Home, Long 
Form, VA Form 10-1465-6--3,333 hours.
    Estimated Average Burden per Respondent:
    a. Inpatient Short Form, VA Form 10-1465-2--15 minutes.
    b. Ambulatory Care Long Form, VA Form 10-1465-3--25 minutes.
    c. Ambulatory Care Short Form, VA Form 10-1465-4--20 minutes.
    d. Clinician and Group Survey Patient Centered Medical Home, Short 
Form, VA Form 10-1465-5--15 minutes.
    e. Clinician and Group Survey Patient Centered Medical Home, Long 
Form, VA Form 10-1465-6--25 minutes.
    Frequency of Response: On occasion.
    Estimated Number of Respondents:
    a. Inpatient Short Form, VA Form 10-1465-2--75,000.
    b. Ambulatory Care Long Form, VA Form 10-1465-3--23,524.
    c. Ambulatory Care Short Form, VA Form 10-1465-4--126,700.
    d. Clinician and Group Survey Patient Centered Medical Home, Short 
Form, VA Form 10-1465-5--20,000.
    e. Clinician and Group Survey Patient Centered Medical Home, Long 
Form, VA Form 10-1465-6--3,333.

    Dated: October 15, 2012.

    By direction of the Secretary.
William F. Russo,
Deputy Director, Office of Regulations Policy and Management, Office of 
the General Counsel, Department of Veterans Affairs.
[FR Doc. 2012-25748 Filed 10-18-12; 8:45 am]
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