Applications & Appraisals for Employment for Title 38 Positions and Trainees

Forms and Documents

Document Name	Status
Form VA Form 10-2850 Applications & Appraisals for Employment for Title 38 Positions and Trainees Form and Instruction	Modified
2900-0205 justification.docx Supporting Statement A	2012-06-14

IC Document Collections

IC ID	Document Title	Status
28443	Applications & Appraisals for Employment for Title 38 Positions and Trainees Form and Instruction	Modified

ICR Details

OMB Control No: 2900-0205	ICR Reference No: 201203-2900-002
Status: Historical Active	Previous ICR Reference No: 200812-2900-007
Agency/Subagency: VA	Agency Tracking No: 2900-0205
Title: Applications & Appraisals for Employment for Title 38 Positions and Trainees
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: 08/08/2012
	Date Received in OIRA: 06/15/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2015	36 Months From Approved	08/31/2012
Responses	412,787	0	327,048
Time Burden (Hours)	153,833	0	129,972
Cost Burden (Dollars)	0	0	0

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Abstract: The information obtained on these data collection instruments enables VHA officials to evaluate qualification for employment and training as well as education and professional experience to determine suitability, grade level and clinical privileges.

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Authorizing Statute(s): US Code: 38 USC 7403 Name of Law: Veterans Benefits - Period of appointments; promotions
   US Code: 38 USC 7401 (1),(3) Name of Law: Appointments in Veterans Health Administration
   US Code: 38 USC 7302 - Part V, Chapter 73 Name of Law: Healthcare Personnel Education and Training Program
  

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:
	77 FR 50	03/14/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 100	05/23/2012
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
Applications & Appraisals for Employment for Title 38 Positions and Trainees	VA FL 10-341(b), VA Form 10-2850a, VA Form 10-2850d, VA FL 10-341(a), VA Form 10-2850, VA Form 10-2850C, VA form 10-2850b	APPLICATION FOR PHYSICIANS, DENTISTS, PODIATRISTS, OPTOMETRISTS AND CHIROPRACTORS ,   APPLICATION FOR ASSOCIATED HEALTH OCCUPATIONS ,   Application for Health Professions Trainees ,   Employment Reference for Title 38 Employee ,   Trainee Qualification and Credentials Verification Letter (TQCVL) ,   APPLICATION FOR NURSES AND NURSE ANESTHETISTS ,   Application for Residents

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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	412,787	327,048	0	0	85,739	0
Annual Time Burden (Hours)	153,833	129,972	0	0	23,861	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: The increase in burden hours is a result of increased applications for VA Form 10-2850d, and FL 10-341b.

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Annual Cost to Federal Government: $24,242,241

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]? 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: 06/15/2012

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