Agent Orange Registry Code Sheet

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10-9009 Agent Orange Registry Code Sheet	Form	Modified	Available
2900-0376 justification.doc	Supporting Statement A	Uploaded 0000-00-00	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
28576	Agent Orange Registry Code Sheet	Form	Modified

ICR Details

OMB Control No: 2900-0376	ICR Reference No: 200702-2900-002
Status: Historical Active	Previous ICR Reference No: 200403-2900-008
Agency/Subagency: VA	Agency Tracking No: 2900-0376
Title: Agent Orange Registry Code Sheet
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/11/2007
	Date Received in OIRA: 03/01/2007
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2010	36 Months From Approved	04/30/2007
Responses	21,000	0	36,000
Time Burden (Hours)	7,000	0	12,000
Cost Burden (Dollars)	0	0	0

---

Abstract: This records symptoms, reproductive health problems and diagnoses detected during the Agent Orange Registry examination process and identifies veterans interested in knowing of health risks, research findings and new compensation policies through newsletters.

---

Authorizing Statute(s): US Code: 38 USC Section 527 Name of Law: Evaluation and data collection
   PL: Pub.L. 100 - 687 Entirety Name of Law: Veterans' Judicial Review Act of 1988
   PL: Pub.L. 102 - 585 703 Name of Law: Veterans Health Care Act of 1992
  

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:
	71 FR 234	12/06/2006
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 38	02/27/2007
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Agent Orange Registry Code Sheet	10-9009	Agent Orange Registry Code Sheet

---

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	21,000	36,000	0	-15,000	0	0
Annual Time Burden (Hours)	7,000	12,000	0	0	-5,000	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: The reduction in the number of respondents and burden hours is a result of fewer individuals requesting this exam. This is considered an adjustment.

---

Annual Cost to Federal Government: $648,631

Does this IC contain surveys, censuses, or employ statistical methods? No

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

---

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: 03/01/2007

---