Army Chemical Corps Vietnam Health Study, VA Form 10-20998 (NR)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability

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Information collection document groups

IC ID	Collection	Type	Status	Form
28744	Army Chemical Corps Vietnam Health Study, VA Form 10-20998 (NR)	Form	Migrated

ICR Details

OMB Control No: 2900-0563	ICR Reference No: 199607-2900-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No:
Title: Army Chemical Corps Vietnam Health Study, VA Form 10-20998 (NR)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/13/1996
	Date Received in OIRA: 07/09/1996
Terms of Clearance: OMB approves the Phase I/Pilot of this study through 3/98 under the following conditions: 1) the VA immediately incorporates the disclosure statements mandated by the Paperwork Reduction Act of 1995. For the public record, the VA must submit to OMB the revised forms/instructions; 2) in the next submission for OMB review, the VA includes an analysis of the pilot. Such an analy- sis must include an evaluation of general and item nonresponse, nonresponse bias, and the validity of self-reported data when compared to VA medical records. In addition, the VA must design follow-up procedures and conduct this pilot with the objective of achieving an 80% response rate for Phase II; 3) the next submission for OMB review must include an assessment of the reliability and validity of paternal responses to questions on reproductive outcomes and maternal health behaviors; and 4) the next submission for OMB review must describe how the VA will compare the findings of this study to other Agent Orange research such as the CDC Vietnam Experience Study and the VA's Study of Reproductive Health Outcomes Among Women Vietnam Veterans.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/1998	03/31/1998
Responses	650	0	0
Time Burden (Hours)	325	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This studies indications that Army Chemical Corps Vietnam Veterans and their families suffer from unusually high rates of illness and the relationship between health outcomes and possible exposure. The focus will include cancer, pregnancy outcomes, birth outcomes, childhood cancer and infertility.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Army Chemical Corps Vietnam Health Study, VA Form 10-20998 (NR)	10-20998

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ICR Summary of Burden

table that charts list of burden

	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	650	0	0	650	0	0
Annual Time Burden (Hours)	325	0	0	325	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

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]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 07/09/1996

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