VA Omnibus Medication Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
VA Withdrawal.doc	Supplementary Document	Uploaded 2009-06-02	Repair queued
2nd Reminder Contact letter.doc	Supplementary Document	Uploaded 2008-08-01	Repair queued
1st Reminder letter.doc	Supplementary Document	Uploaded 2008-08-01	Repair queued
Initial Contact letter.doc	Supplementary Document	Uploaded 2008-08-01	Repair queued
Omnibus Justification_Part_A.doc	Supporting Statement A	Uploaded 2008-08-01	Repair queued
Justification Part B.doc	Supporting Statement B	Uploaded 2007-09-14	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
181349	Omnibus Medication Survey	Other-Omnibus Medication Survey with Cover letter	New

ICR Details

OMB Control No:	ICR Reference No: 200707-2900-049
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No:
Title: VA Omnibus Medication Survey
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OIRA Conclusion Action: Withdrawn	Conclusion Date: 06/15/2009
	Date Received in OIRA: 08/01/2008
Terms of Clearance: Withdrawn per VA request.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This survey will enable VA Pharmacy Benefits Management Strategic Health Care Group (PBM) to incorporate the veterans’ perspective into the policy making process, specifically in areas where there is a paucity of information about the veterans. The survey will enable the PBM to collect information mainly in the following areas: the veterans reported side effects of medications, veterans reported adherence to medications, veteran’s prescription and over-the-counter (OTC) medications obtained from outside the VA and the veterans reported health related quality of life.

---

Authorizing Statute(s): US Code: 38 USC 527 Name of Law: Evaluation and data collection
  

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:
	72 FR 189	10/01/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 238	12/12/2007
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
Omnibus Medication Survey

---

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

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This will be the first administration of the Omnibus Medication Survey, therefore, all hours will be considered a program increase.

---

Annual Cost to Federal Government: $525,000

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

---

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: 08/01/2008

---