ONE YEAR POST-EXIT PILOT STUDY OF FORMER VHA EMPLOYEES

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VA Form 10-0478 Veterans Health Administration One Year Post-Exit Survey Pilot Study	Form	New	Repair queued
RE Post-Exit Survey Pilot Study.msg	Supplementary Document	Uploaded 2011-10-14	Repair queued
Timeline to 005R1B.docx	Supplementary Document	Uploaded 2011-10-12	Repair queued
Post-Exit Pilot_ OMB D_Heim 2nd Request for Revisions.docx	Supplementary Document	Uploaded 2011-10-11	Repair queued
Post-Exit Pilot_ OMBComments_VA_Response to D_Heim.docx	Supplementary Document	Uploaded 2011-10-11	Repair queued
2010 HRRO VA CAREERS FAQ Scripts- Revised.docx	Supplementary Document	Uploaded 2011-10-11	Repair queued
Post-Exit Questionnaire Call Center Script.docx	Supplementary Document	Uploaded 2011-10-11	Repair queued
Postcard_letter .docx	Supplementary Document	Uploaded 2011-10-11	Repair queued
Justification B Revised 4-13-11.docx	Supporting Statement B	Uploaded 2011-10-11	Repair queued
Justification A Revised 4-13-11.docx	Supporting Statement A	Uploaded 2011-10-11	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
199714	Veterans Health Administration One Year Post-Exit Survey Pilot Study	Form	New

ICR Details

OMB Control No:	ICR Reference No: 201110-2900-007
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No:
Title: ONE YEAR POST-EXIT PILOT STUDY OF FORMER VHA EMPLOYEES
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OIRA Conclusion Action: Withdrawn	Conclusion Date: 11/16/2011
	Date Received in OIRA: 10/14/2011
Terms of Clearance: Per request from VA (11-16-11), this collection is withdrawn.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		12 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 Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) desires to conduct a one-year pilot survey for employees from VHA's top fifteen occupations who have left the Agency between three and six months prior to the survey. The purpose of this pilot is to collect and analyze the data to provide VHA leadership with information on how to increase workforce retention throughout the system. Although VA possesses an online exit survey, a one-year pilot for these recently separated employees would strengthen VHA's ability to develop strategic objectives to increase workforce readiness to better support the needs of our Nations' Veterans and their families.

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Authorizing Statute(s): US Code: 38 USC Part I, Chapter 5, Section 527 Name of Law: Program Evaluation and Measurement
  

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 105	06/02/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 153	08/10/2010
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
Veterans Health Administration One Year Post-Exit Survey Pilot Study	VA Form 10-0478	VHA Post-Exit 1 Year Pilot Survey Study

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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: $75,000

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: 10/14/2011

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