Prevalence and Clinical Course of Depression Among Patients with Heart Failure, VA HSR&D, Nursing Research Initiative No. 05-209-3

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VA Form 10-21085a, Prevalence and Clinical Course of Depression Among Patients with Heart Failure	Form and Instruction	Modified	Repair queued
Gantt Chart_Corvera-Tindel.doc	Supplementary Document	Uploaded 2011-12-19	Available
Supporting Statement Part B 12_11.doc	Supporting Statement B	Uploaded 2011-12-19	Available
2900-0719 justification.docx	Supporting Statement A	Uploaded 2011-12-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
184350	Prevalence and Clinical Course of Depression Among Patients with Heart Failure, VA HSR&D, Nursing Research Initiative No. 05-209-3	Form and Instruction	Modified	Prevalence and Clinical Course of Depression Among Patients with Heart Failure

ICR Details

OMB Control No: 2900-0719	ICR Reference No: 201110-2900-002
Status: Historical Active	Previous ICR Reference No: 200804-2900-010
Agency/Subagency: VA	Agency Tracking No: 2900-0719
Title: Prevalence and Clinical Course of Depression Among Patients with Heart Failure, VA HSR&D, Nursing Research Initiative No. 05-209-3
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: 01/30/2012
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/21/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2015	36 Months From Approved	01/31/2012
Responses	5,014	0	5,014
Time Burden (Hours)	1,362	0	1,362
Cost Burden (Dollars)	0	0	0

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Abstract: This application is submitted for the collection of the necessary information for the research study, ‘Prevalence and Clinical Course of Depression among Patients with Heart Failure’. This is a single-center, prospective longitudinal research study conducted among Veterans with heart failure (HF). The overall intent of this study is to identify the patterns of depression in HF over time and to understand the temporal relationship between clinical depression, alterations in physical functioning, and levels of circulating biochemical markers in a highly vulnerable Veterans HF patient population. Knowledge regarding temporal relationships is vital to understanding how pathologic mechanisms of HF and depression interact and ultimately to designing optimal and complementary interventions for both conditions.

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Authorizing Statute(s): US Code: 38 USC PT 1 Chapter 5, Section 527 Name of Law: Evaluation and data collection
  

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:
	76 FR 197	10/12/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 243	12/19/2011
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
Prevalence and Clinical Course of Depression Among Patients with Heart Failure, VA HSR&D, Nursing Research Initiative No. 05-209-3	VA Form 10-21085a, b,c,d,e	Prevalence and Clinical Course of Depression Among Patients with Heart Failure

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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	5,014	5,014	0	0	0	0
Annual Time Burden (Hours)	1,362	1,362	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:

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Annual Cost to Federal Government: $51,406

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: 12/21/2011

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