VA/DOD Joint Disability Evaluation Claim

Forms and Documents

Document Name	Status
Form VA Form 21-0819 VA/DOD Joint Disability Evaluation Board Claim Form	New
21-0819 justification.doc Supporting Statement A	2007-09-07

IC Document Collections

IC ID	Document Title	Status
181456	VA/DOD Joint Disability Evaluation Board Claim Form	New

ICR Details

OMB Control No: 2900-0704	ICR Reference No: 200708-2900-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No:
Title: VA/DOD Joint Disability Evaluation Claim
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 09/30/2007
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/19/2007
	Date Received in OIRA: 09/17/2007
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2008	6 Months From Approved
Responses	14,000	0	0
Time Burden (Hours)	7,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This form will be used in a joint effort between VA and the Department of Defense (DOD) as recommended by President Bush's Interagency Task Force on Returning Global War on Terror Heroes, to determine an injured or ill Global War on Terrorism (GWOT) service member's military readiness fitness for military retention, level of disability for retirement, and VA Disability Compensation.

Emergency Justfication: As a result of President Bush’s Interagency Task Force on Returning Global War on Terror Heroes, VA and the Department of Defense (DOD) have agreed to develop a joint process in which Global War on Terror (GWOT) service member’s are evaluated to assign disability ratings, which will be used to determine military retention, level of disability for retirement, and VA disability compensation. In an effort to streamline the process, VA and DOD developed a form that will be used to identify these service members and help to determine the medical conditions, that may qualify them DOD and/or VA benefits. Therefore, we are requesting emergency approval of VA Form 21-0819, VA/DOD Joint Disability Evaluation Board Claim, to adhere to the Task Force recommendations to improve the timeliness, ease of application, and delivery of services and benefits to GWOT service members. VA and DOD have agreed to a one–year pilot program to begin on October 1, 2007. VA Form 21-0819 is an essential element to this joint effort and is key to the success of this initiative. In addition, both Houses of Congress have approved bills for this program: the House Bill is H-1538 and the Senate Bill is S-1606.

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Authorizing Statute(s): US Code: 38 USC 5101 Name of Law: Veteran's Benefits
  

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 167	08/29/2007
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
VA/DOD Joint Disability Evaluation Board Claim	VA Form 21-0819	VA/DOD Joint Disability Evaluation Board Claim

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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	14,000	0	0	14,000	0	0
Annual Time Burden (Hours)	7,000	0	0	7,000	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: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: As a result of President Bush’s Interagency Task Force on Returning Global War on Terror Heroes, VA and the Department of Defense (DOD) have agreed to develop a joint process in which Global War on Terror (GWOT) service member’s are evaluated to assign disability ratings, which will be used to determine military retention, level of disability for retirement, and VA disability compensation. In an effort to streamline the process, VA and DOD developed a form that will be used to identify these service members and help in determining the medical conditions, which may qualify them DOD and/or VA benefits. Therefore, we are requesting emergency approval of VA Form 21-0819, VA/DOD Joint Disability Evaluation Board Claim, to adhere to the Task Force recommendations to improve the timeliness, ease of application, and delivery of services and benefits to GWOT service members. VA and DOD have agreed to a one–year pilot program to begin on October 1, 2007. VA Form 21-0819 is an essential element to this joint effort and is key to the success of this initiative. In addition, both Houses of Congress have approved bills for this program: the House Bill is H-1538 and the Senate Bill is S-1606.

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Annual Cost to Federal Government: $429,104

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

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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: 09/17/2007

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