Application Requirements to Receive VA Dental Insurance Plan Benefits under 38 CFR 17.169; RIN 2900-AN99

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
VADIP_Fact_Sheet_v14.pdf	Supplementary Document	Uploaded 2014-01-28	Available
DownloadNOA.pdf	Supplementary Document	Uploaded 2013-08-26	Available
2900-0789 Application for Dental Insurance.docx	Supporting Statement A	Uploaded 2013-01-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
202798	Application Requirements to Receive VA Dental Insurance Plan Benefits under 38 CFR 17.169; RIN 2900-AN99	Other-Fact Sheet	Modified

ICR Details

OMB Control No: 2900-0789	ICR Reference No: 201301-2900-002
Status: Historical Active	Previous ICR Reference No: 201206-2900-010
Agency/Subagency: VA	Agency Tracking No:
Title: Application Requirements to Receive VA Dental Insurance Plan Benefits under 38 CFR 17.169; RIN 2900-AN99
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: 01/30/2014
	Date Received in OIRA: 09/03/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2017	36 Months From Approved
Responses	283,500	0	0
Time Burden (Hours)	38,350	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 510 of title III of the Caregivers and Veterans Omnibus Health Services Act of 2010 (section 510) requires VA to establish a new program to offer private, premium-based dental insurance to enrolled veterans and certain survivors and dependents of veterans. Section 510 requires VA to contract with a private insurer (using the Federal contracting process) to offer dental insurance, and the private insurer will be responsible for virtually all aspects of the administration of the dental insurance program.

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Authorizing Statute(s): PL: Pub.L. 111 - 163 510(C) Name of Law: Pilot program on provision of dental insurance plans to
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AN99	Final or interim final rulemaking	77 FR 41	03/01/2012

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Federal Register Notices & Comments

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
Application Requirements to Receive VA Dental Insurance Plan Benefits under 38 CFR 17.169; RIN 2900-AN99

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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	283,500	0	0	283,500	0	0
Annual Time Burden (Hours)	38,350	0	0	38,350	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 request for clearance of OMB control number 2900-0789, as provided by OMB for placement in publishing the Final Rule (RIN 2900-AN99).

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Annual Cost to Federal Government: $0

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: 09/03/2013

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