Survey of Veteran Enrollees' Health and Reliance Upon VA

Forms and Documents

Document Name	Status
Form 10-21034G Survey of Veteran Enrollees' Health and Reliance Upon VA Form	Modified
Justification Part B.doc Supporting Statement B	2007-03-01
Justification Part A.doc Supporting Statement A	2007-03-01

IC Document Collections

IC ID	Document Title	Status
28855	Survey of Veteran Enrollees' Health and Reliance Upon VA Form	Modified

ICR Details

OMB Control No: 2900-0609	ICR Reference No: 200703-2900-001
Status: Historical Active	Previous ICR Reference No: 200512-2900-007
Agency/Subagency: VA	Agency Tracking No: 2900-0609
Title: Survey of Veteran Enrollees' Health and Reliance Upon VA
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: 01/02/2008
	Date Received in OIRA: 06/28/2007
Terms of Clearance: Approved for a period of 18 months, after which VA will present the results of the clearance period to OMB and request an extension of the collection. Specifically, VA shall address response rates, the results of non-response bias analysis, and Dept. efforts to update/match contact information for Veterans during this clearance.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2009	36 Months From Approved	12/31/2007
Responses	42,200	0	42,200
Time Burden (Hours)	10,900	0	10,900
Cost Burden (Dollars)	0	0	0

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Abstract: Study of enrollees' health status, income, reliance on VA & interest in Prescription-Only Program will provide information for planning & policy development for actuarial projections of enrollment, utilization, expenditures, mandated annual enrollment reforms, & quantitative & qualitative research.

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Authorizing Statute(s): PL: Pub.L. 104 - 262 Entirety Name of Law: Veterans Health Care Eligibility Reform Act of 1996,
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 38	02/27/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 117	06/19/2007
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Survey of Veteran Enrollees' Health and Reliance Upon VA	10-21034G	SURVEY OF VETERAN ENROLLEES� HEALTH AND RELIANCE UPON VA

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ICR Summary 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	42,200	42,200	0	0	0	0
Annual Time Burden (Hours)	10,900	10,900	0	0	0	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:

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Annual Cost to Federal Government: $819,000

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: 06/28/2007

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