Customer Satisfaction Survey for Nutrition and Food Service

Forms and Documents

Document Name	Status
Form VA Form 10-5387 Customer Satisfaction Survey for Nutrition and Food Service Form	Unchanged
2900-0227_justification[1].docx Supporting Statement A	2012-10-22

IC Document Collections

IC ID	Document Title	Status
44124	Customer Satisfaction Survey for Nutrition and Food Service Form	Unchanged

ICR Details

OMB Control No: 2900-0227	ICR Reference No: 201207-2900-007
Status: Historical Inactive	Previous ICR Reference No: 200907-2900-005
Agency/Subagency: VA	Agency Tracking No: 2900-0227
Title: Customer Satisfaction Survey for Nutrition and Food Service
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 02/22/2013
	Date Received in OIRA: 10/22/2012
Terms of Clearance: This collection will be resubmitted under the following control number: 2900-0770.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2012	36 Months From Approved	02/28/2013
Responses	125,600	0	125,600
Time Burden (Hours)	4,187	0	4,187
Cost Burden (Dollars)	0	0	0

---

Abstract: VA can achieve significant savings through advanced food preparation and advanced food delivery systems. To determine the level of patient satisfaction and quality of services provided, the survey is needed to be performed at the medical centers. The on-going quarterly survey is essential to providing Nutrition and Food Service personnel with reliable, timely information on the quality of food and nutritional services provided to veteran patients.

---

Authorizing Statute(s): US Code: 38 USC Section 219 Name of Law: Veterans Benefits
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 148	08/01/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 203	10/18/2012
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Customer Satisfaction Survey for Nutrition and Food Service	VA Form 10-5387	Customer Satisfaction Survey for Nutrition and Food Service

---

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $72,597

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 10/22/2012

---