VSO Access to VHA Electronic Health Records

Forms and Documents

Document Name	Status
Form 10-0400 VSO Access to VHA Electronic Health Record Form and Instruction	New
VSO Pilot justification1[2].doc Supporting Statement A	2008-01-02

IC Document Collections

IC ID	Document Title	Status
183126	VSO Access to VHA Electronic Health Record Form and Instruction	New

ICR Details

OMB Control No: 2900-0710	ICR Reference No: 200712-2900-020
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No:
Title: VSO Access to VHA Electronic Health Records
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: 01/25/2008
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/24/2008
	Date Received in OIRA: 01/03/2008
Terms of Clearance: Approved for 6 months during which time VA shall seek a normal clearance for the collection of information including both a 60 and 30 day public comment period.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2008	6 Months From Approved
Responses	80	0	0
Time Burden (Hours)	3	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The information is being used to establish VA Veterans Health Information Systems Technology Architecture (VistA) computer accounts for Veteran Service Officers (VSO’s) who have been granted Power Of Attorney by veterans who have medical information recorded in VA electronic health records.

Emergency Justfication: This is a small pilot project to test the form data and submission processes before going to a full scale project. Veterans Service Organizations have requested a rapid deployment.

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Authorizing Statute(s): US Code: 38 USC Part I Chapter 5 Name of Law: VETERANS' 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

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
VSO Access to VHA Electronic Health Record	10-0400	VSO Access to VHA Electronic Health Record

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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	80	0	0	80	0	0
Annual Time Burden (Hours)	3	0	0	3	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 information collection

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Annual Cost to Federal Government: $183

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: 01/03/2008

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