A Veteran's Faith: Spirituality Influences Coping with Cancer

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VA form 10-21093(A A Veteran's Faith: Spirituality Influences Coping with Cancer	Form	New	Repair queued
VA Faith Withdrawal Request.doc	Supplementary Document	Uploaded 2010-08-26	Repair queued
Justification B.doc	Supporting Statement B	Uploaded 2009-07-29	Repair queued
10-21093a-c justification.doc	Supporting Statement A	Uploaded 2009-09-03	Repair queued
R&D approval.PDF	Supplementary Document	Uploaded 2009-03-04	Repair queued
IRB approval.PDF	Supplementary Document	Uploaded 2009-03-04	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
188210	A Veteran's Faith: Spirituality Influences Coping with Cancer	Form	New

ICR Details

OMB Control No:	ICR Reference No: 200903-2900-002
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No:
Title: A Veteran's Faith: Spirituality Influences Coping with Cancer
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OIRA Conclusion Action: Withdrawn	Conclusion Date: 08/29/2010
	Date Received in OIRA: 09/03/2009
Terms of Clearance: Withdrawn per the request of the Department of Veterans Affairs.

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

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Abstract: The purpose of this study is to determine if there is a relationship between spirituality and a Veteran's ability to cope with cancer. Data collected will be used to implement measures to better address spiritual needs and improve quality of life in the Veteran with cancer.

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Authorizing Statute(s): US Code: 38 USC Part I, Chapter 5, Section 527 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
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 71	04/15/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 118	06/22/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
A Veteran's Faith: Spirituality Influences Coping with Cancer	VA form 10-21093(A), VA Form 10-21093(B), VA Form 10-21093(C)	A Veterans Faith: Spirituality Influences Coping with Cancer - Demographic Data ,   A Veterans Faith: Spirituality Influences Coping with Cancer - Spiritual Beliefs Inventory ,   A Veterans Faith: Spirituality Influences Coping with Cancer - Prolonged Grief Scale

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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 collection and all burden hours are considered a program increase.

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Annual Cost to Federal Government: $0

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)? No

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: 09/03/2009

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