Application of Service Representative for Placement on Mailing List, Request for & Consent to Release of Info from Claimant's Records, Requests to Correspondent for Identifying Info, 38 CFR 1.519(A)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 3215 Application of Service Representaive for Placement on Mailing List, Request for & Consent to Release of Infor. from Claimant's Records, Requests to Correspondent for Identifying Infor., 38 CFR	Form	Modified	Repair queued
2900-0028.doc	Supporting Statement A	Uploaded 2008-02-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
28126	Application of Service Representaive for Placement on Mailing List, Request for & Consent to Release of Infor. from Claimant's Records, Requests to Correspondent for Identifying Infor., 38 CFR	Form	Modified

ICR Details

OMB Control No: 2900-0028	ICR Reference No: 200710-2900-027
Status: Historical Active	Previous ICR Reference No: 200510-2900-005
Agency/Subagency: VA	Agency Tracking No: 2900-0028
Title: Application of Service Representative for Placement on Mailing List, Request for & Consent to Release of Info from Claimant's Records, Requests to Correspondent for Identifying Info, 38 CFR 1.519(A)
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: 04/09/2008
	Date Received in OIRA: 02/20/2008
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2011	36 Months From Approved	11/30/2008
Responses	196,200	0	196,200
Time Burden (Hours)	22,700	0	22,700
Cost Burden (Dollars)	0	0	0

---

Abstract: 3215 is used to process requests from service organizations to be place on specific VA publications mailing list. 3288 is completed by VA beneficiaries to provide VA with written consent to release records or information to a third party. 70-2 is used to get additional information from a correspondent when the incoming correspondence does not give enough information to identify a specific veteran. Information collected for list of names and addresses is used to determine whether an applicant is eligible to receive an address list.

---

Authorizing Statute(s): US Code: 38 USC 5904 Name of Law: Recognition of agents and attorneys generally
   US Code: 38 USC 7722 Name of Law: Outreach services
   US Code: 38 USC 5701 Name of Law: Confidential nature of claims
   US Code: 5 USC 552a Name of Law: Records maintained on individuals
  

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 221	11/16/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 21	01/31/2008
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
Application of Service Representaive for Placement on Mailing List, Request for & Consent to Release of Infor. from Claimant's Records, Requests to Correspondent for Identifying Infor., 38 CFR	3215, 3288, FL 70-2	Application of Service Representative for Placement on Mailing List ,   Request for and Consent to Release of Information from Claimant�s Records ,   Request to Correspondent for Identifying Information

---

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	196,200	196,200	0	0	0	0
Annual Time Burden (Hours)	22,700	22,700	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:

---

Annual Cost to Federal Government: $491,093

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: 02/20/2008

---