NATIONAL SURVEY OF WOMEN VETERANS

Forms and Documents

Document Name	Status
Form 10-21086(NR) National Survey of Women Veterans Form	New
10-21086 Part B.pdf Supporting Statement B	2008-04-04
10-21086 justification.doc Supporting Statement A	2008-04-21

IC Document Collections

IC ID	Document Title	Status
182861	National Survey of Women Veterans Form	New

ICR Details

OMB Control No: 2900-0714	ICR Reference No: 200711-2900-009
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No:
Title: NATIONAL SURVEY OF WOMEN VETERANS
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: Approved with change	Conclusion Date: 08/25/2008
	Date Received in OIRA: 04/21/2008
Terms of Clearance: Approved consistent with the following terms of clearance: given the projected response rate for the survey VA shall perform an analysis of non-response bias, additionally upon completion of the survey VA shall provide OMB with a report detailing results.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2011	36 Months From Approved
Responses	3,500	0	0
Time Burden (Hours)	2,625	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This collection is a national telephone survey of women veterans, which will assist the Department of Veterans Affairs (VA) in identifying the changing healthcare needs of the growing women veteran population, and the barriers they experience with VA healthcare use. Survey measures include demographic and military information, health status, VA and non-VA healthcare usage, and barriers to VA use. The information will be used by the VA to plan for future healthcare services for women veterans.

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Authorizing Statute(s): None

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:
	73 FR 4	01/07/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 61	03/28/2008
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
National Survey of Women Veterans	10-21086(NR)	National Survey of Women Veterans

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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	3,500	0	0	3,500	0	0
Annual Time Burden (Hours)	2,625	0	0	2,625	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: This is a new data collection; all hours are considered a program increase

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Annual Cost to Federal Government: $420,500

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: 04/21/2008

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