Follow-Up Study of a National Cohort of Gulf War and Gulf Era Veterans

Forms and Documents

Document Name	Status
Form VA Form 10-0488 Follow-Up Study of a National Cohort of Gulf War and Gulf Era Veterans Form and Instruction	New
Responses to OMB.docx Supplementary Document	2012-02-25
10-0488 Justification_A12012 2 16.docx Supporting Statement A	2012-02-27
Veterans Consent Cover Letter for Medical Records.doc Supplementary Document	2010-08-24
Provider Cover Letter for Veterans Medical Records.doc Supplementary Document	2010-08-24
OMB Justification B (v3)2010.doc Supporting Statement B	2010-08-24
GWI and Health of GW Veterans_RAC-GWVI Report.pdf Supplementary Document	2010-08-19

IC Document Collections

IC ID	Document Title	Status
192951	Follow-Up Study of a National Cohort of Gulf War and Gulf Era Veterans Form and Instruction	New

ICR Details

OMB Control No: 2900-0780	ICR Reference No: 201005-2900-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No:
Title: Follow-Up Study of a National Cohort of Gulf War and Gulf Era 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: 02/27/2012
	Date Received in OIRA: 04/18/2011
Terms of Clearance: In accordance with 5 CFR, this information collection is approved. However, VA will upload, via non-substantive change request, the telephone script for the follow-up call within 60 days of this approval. VA and OMB have agreed that VA and its contractor will provide an analysis plan for conducting more robust nonresponse bias analyses to OMB within 6 months from approval of this collection. This analysis will leverage the information VA has collected from earlier waves and will also address differential nonresponse between deployed and non-deployed Veterans. VA will provide a copy of the report of the results from these analyses to OMB when they are completed. If VA fails to provide the information required, OMB may revisit this approval.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2015	36 Months From Approved
Responses	19,462	0	0
Time Burden (Hours)	9,498	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The information obtained from this survey will provide a comprehensive understanding of the experiences and health concerns(both chronic and time dependent)of Gulf War Veterans.

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Authorizing Statute(s): US Code: 38 USC Part 1, 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:
	75 FR 172	09/07/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 221	11/17/2010
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Follow-Up Study of a National Cohort of Gulf War and Gulf Era Veterans	VA Form 10-0488a , VA Form 10-0488	Follow-Up Study of a National Cohort of Gulf War and Gulf Era Veterans ,   Consent to Release Medical Records

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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	19,462	0	0	19,462	0	0
Annual Time Burden (Hours)	9,498	0	0	9,498	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 collection. All hours are considered a program change.

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Annual Cost to Federal Government: $1,231,000

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 04/18/2011

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