VA National Rehabilitation Special Events Forms

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0929d Travel Information National Veterans Creative Arts Festival	Form	Modified	Available
Form VA0925 (SF) Veteran Registration Form	Form	Modified	Available
Form 0927f Volunteer Registration Application, National Veterans Tee Tournament	Form	Modified	Available
Form 0927e Participant, Companion and Volunteer Fees, National Veterans Tee Tournament	Form	Modified	Available
Form 0926g National Veterans Golden Age Games, Non-Competitor Registration Check List	Form	Modified	Available
Form 0929h Media and News Release Questionnair, National Veterans Creative Arts Festival	Form	Modified	Available
Form 0929g Ticket Request Form for Visual and Performing Arts Participants, National Veterans Creative Arts Festival Art and Exhibit & Stage Show	Form	Modified	Available
Form 0929f Participant Agreement, National Veterans Creative Arts Festival	Form	Modified	Available
Form 0929e Family and Friends Lodging and Meals, National Veterans Creative Arts Festival	Form	Modified	Available
Form 0929c Participant Medical Information, National Veterans Creative Arts Festival	Form	Modified	Available
Form 0929b Participant Registration Application, National Veterans Creative Arts Festival	Form	Modified	Available
Form 0929a National Veterans Creative Arts Festival, Participant Registration Check List	Form	Modified	Available
Form 0928j Venue Personnel Application, National Veterans Summer Sports Clinic	Form	Modified	Available
Form 0928i Surfing Personnel Application, National Veterans Summer Sports Clinic	Form	Modified	Available
Form 0928h Volunteer Application, National Veterans Summer Sports Clinic	Form	Modified	Available
Form 0928c General Medical/Physical Exam Form, National Veterans Summer Sports Clinic	Form	Modified	Available
Form 0928a National Veterans Summer Sports Clinic, Registration Check List	Form	Modified	Available
Form 0927c Participant Registration Form-Physical Exam, National Veterans Tee Tournament	Form	Modified	Available
Form 0926j Volunteer Application, National Veterans Golden Age Games	Form	Modified	Available
Form 0926h Non-Competitor Application, National Veterans Golden Age Games	Form	Modified	Available
Form 0926e Athlete Medical Information	Form and Instruction	Modified	Available
Form 0926d Waivers and Release of Liability and Other Use Release, National Veterans Golden Age Games	Form	Modified	Available
Form 0926b Athlete Application, National Veterans Golden Age Games	Form	Modified	Available
Form 0926a National Veterans Golden Age Games, Registration Check List	Form	Modified	Available
Form 0925d Voluntary Service Application, National Veterans Wheelchair Games	Form	Modified	Available
Form 0925b General Medical Form	Form	Modified	Available
Form 0924t Volunteer Application, National Disabled Veterans Winter Sports Clinic	Form	Modified	Available
Form 0924s Downhill Ski Instruction Personnel Application, National Disabled Veterans Winter Sport Clinic	Form	Modified	Available
Form 0924n Cross Country Ski Instructor Personnel Application, National Disabled Veterans Winter Sport Clinic	Form	Modified	Available
Form 0924d General Medical/Physical Exam Form, National Disabled Veterans Winter Sport Clinic	Form	Modified	Available
Form 0924c General Ski Information, National Disabled Veterans Winter Sport Clinic	Form	Modified	Available
Form 0924a National Disabled Veterans Winter Sports Clinic, Registration Check List	Form	Modified	Available
Form 0927a National Veterans Tee Tournament, Registration Check List	Form	Modified	Available
Justification 2900-0759 SS (14APR14).doc	Supporting Statement A	Uploaded 2014-04-14	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
193170	VA National Rehabilitation Special Events	Form	Modified	Travel Information National Veterans Creative Arts Festival
193170	VA National Rehabilitation Special Events	Form	Modified	Veteran Registration Form
193170	VA National Rehabilitation Special Events	Form	Modified	Volunteer Registration Application, National Veterans Tee Tournament
193170	VA National Rehabilitation Special Events	Form	Modified	Participant, Companion and Volunteer Fees, National Veterans Tee Tournament
193170	VA National Rehabilitation Special Events	Form	Modified	National Veterans Golden Age Games, Non-Competitor Registration Check List
193170	VA National Rehabilitation Special Events	Form	Modified	Media and News Release Questionnair, National Veterans Creative Arts Festival
193170	VA National Rehabilitation Special Events	Form	Modified	Ticket Request Form for Visual and Performing Arts Participants, National Veterans Creative Arts Festival Art and Exhibit & Stage Show
193170	VA National Rehabilitation Special Events	Form	Modified	Participant Agreement, National Veterans Creative Arts Festival
193170	VA National Rehabilitation Special Events	Form	Modified	Family and Friends Lodging and Meals, National Veterans Creative Arts Festival
193170	VA National Rehabilitation Special Events	Form	Modified	Participant Medical Information, National Veterans Creative Arts Festival
193170	VA National Rehabilitation Special Events	Form	Modified	Participant Registration Application, National Veterans Creative Arts Festival
193170	VA National Rehabilitation Special Events	Form	Modified	National Veterans Creative Arts Festival, Participant Registration Check List
193170	VA National Rehabilitation Special Events	Form	Modified	Venue Personnel Application, National Veterans Summer Sports Clinic
193170	VA National Rehabilitation Special Events	Form	Modified	Surfing Personnel Application, National Veterans Summer Sports Clinic
193170	VA National Rehabilitation Special Events	Form	Modified	Volunteer Application, National Veterans Summer Sports Clinic
193170	VA National Rehabilitation Special Events	Form	Modified	General Medical/Physical Exam Form, National Veterans Summer Sports Clinic
193170	VA National Rehabilitation Special Events	Form	Modified	National Veterans Summer Sports Clinic, Registration Check List
193170	VA National Rehabilitation Special Events	Form	Modified	Participant Registration Form-Physical Exam, National Veterans Tee Tournament
193170	VA National Rehabilitation Special Events	Form	Modified	Volunteer Application, National Veterans Golden Age Games
193170	VA National Rehabilitation Special Events	Form	Modified	Non-Competitor Application, National Veterans Golden Age Games
193170	VA National Rehabilitation Special Events	Form and Instruction	Modified	Athlete Medical Information
193170	VA National Rehabilitation Special Events	Form	Modified	Waivers and Release of Liability and Other Use Release, National Veterans Golden Age Games
193170	VA National Rehabilitation Special Events	Form	Modified	Athlete Application, National Veterans Golden Age Games
193170	VA National Rehabilitation Special Events	Form	Modified	National Veterans Golden Age Games, Registration Check List
193170	VA National Rehabilitation Special Events	Form	Modified	Voluntary Service Application, National Veterans Wheelchair Games
193170	VA National Rehabilitation Special Events	Form	Modified	General Medical Form
193170	VA National Rehabilitation Special Events	Form	Modified	Volunteer Application, National Disabled Veterans Winter Sports Clinic
193170	VA National Rehabilitation Special Events	Form	Modified	Downhill Ski Instruction Personnel Application, National Disabled Veterans Winter Sport Clinic
193170	VA National Rehabilitation Special Events	Form	Modified	Cross Country Ski Instructor Personnel Application, National Disabled Veterans Winter Sport Clinic
193170	VA National Rehabilitation Special Events	Form	Modified	General Medical/Physical Exam Form, National Disabled Veterans Winter Sport Clinic
193170	VA National Rehabilitation Special Events	Form	Modified	General Ski Information, National Disabled Veterans Winter Sport Clinic
193170	VA National Rehabilitation Special Events	Form	Modified	National Disabled Veterans Winter Sports Clinic, Registration Check List
193170	VA National Rehabilitation Special Events	Form	Modified	National Veterans Tee Tournament, Registration Check List

ICR Details

OMB Control No: 2900-0759	ICR Reference No: 201304-2900-034
Status: Historical Active	Previous ICR Reference No: 201006-2900-001
Agency/Subagency: VA	Agency Tracking No:
Title: VA National Rehabilitation Special Events Forms
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 04/21/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/30/2013
Terms of Clearance: VA should consider providing an electronic option to respondents for providing information and in the next submission of this collection the Department shall report to OMB on the feasibility of an electronic option.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2017	36 Months From Approved	04/30/2014
Responses	7,688	0	3,775
Time Burden (Hours)	1,048	0	1,257
Cost Burden (Dollars)	0	0	0

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Abstract: VA administers National Rehabilitation Special Events for veterans who are receiving care at VA medical facilities. These events are: The National Disabled Veterans Winter Sports Clinic, National Veterans Wheelchair Games, National Veterans Golden Age Games, National Veterans Creative Arts Festival, National Veterans Summer Sports Clinic and National Veterans TEE Tournament. Each event promotes the healing of body and spirit by motivating eligible veterans to reach their full potential, improve their independence, achieve a healthier lifestyle and enjoy a higher quality of life. Veterans eligible for VA medical care may apply to attend these events using event applications.

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Authorizing Statute(s): US Code: 38 USC Section 521 Name of Law: Assistance to certain rehabilitation activities
   US Code: 38 USC Section 1710 Name of Law: Eligibility for hospital, nursing home, and domiciliary care
   US Code: 38 USC Secti on 513 Name of Law: Contracts and personal services
  

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:
	78 FR 76412	12/17/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 55777	09/11/2013
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
VA National Rehabilitation Special Events	VA0925 (SF), 0929d, 0928c, 0929a, 0929c, 0929e, 0929f, 0928h, 0929g, 0926b, 0929b, 0925b, 0928i, 0924n, 0926j, 0925d, 0929h, 0928a, 0924t, 0926g, 0924a, 0927a, 0927c, 0927e, 0924s, 0926h, 0928j, 0926a, 0926d, 0926e, 0927f, 0924c, 0924d	National Disabled Veterans Winter Sports Clinic, Registration Check List ,   General Ski Information, National Disabled Veterans Winter Sport Clinic ,   General Medical/Physical Exam Form, National Disabled Veterans Winter Sport Clinic ,   Cross Country Ski Instructor Personnel Application, National Disabled Veterans Winter Sport Clinic ,   Downhill Ski Instruction Personnel Application, National Disabled Veterans Winter Sport Clinic ,   Volunteer Application, National Disabled Veterans Winter Sports Clinic ,   General Medical Form ,   Voluntary Service Application, National Veterans Wheelchair Games ,   National Veterans Golden Age Games, Registration Check List ,   Athlete Application, National Veterans Golden Age Games ,   Waivers and Release of Liability and Other Use Release, National Veterans Golden Age Games ,   Athlete Medical Information ,   Non-Competitor Application, National Veterans Golden Age Games ,   Volunteer Application, National Veterans Golden Age Games ,   National Veterans Tee Tournament, Registration Check List ,   Participant Registration Form-Physical Exam, National Veterans Tee Tournament ,   National Veterans Summer Sports Clinic, Registration Check List ,   General Medical/Physical Exam Form, National Veterans Summer Sports Clinic ,   Volunteer Application, National Veterans Summer Sports Clinic ,   Surfing Personnel Application, National Veterans Summer Sports Clinic ,   Venue Personnel Application, National Veterans Summer Sports Clinic ,   National Veterans Creative Arts Festival, Participant Registration Check List ,   Participant Registration Application, National Veterans Creative Arts Festival ,   Participant Medical Information, National Veterans Creative Arts Festival ,   Family and Friends Lodging and Meals, National Veterans Creative Arts Festival ,   Participant Agreement, National Veterans Creative Arts Festival ,   Ticket Request Form for Visual and Performing Arts Participants, National Veterans Creative Arts Festival Art and Exhibit & Stage Show ,   Media and News Release Questionnair, National Veterans Creative Arts Festival ,   National Veterans Golden Age Games, Non-Competitor Registration Check List ,   Participant, Companion and Volunteer Fees, National Veterans Tee Tournament ,   Volunteer Registration Application, National Veterans Tee Tournament ,   Veteran Registration Form ,   Travel Information National Veterans Creative Arts Festival

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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	7,688	3,775	0	3,913	0	0
Annual Time Burden (Hours)	1,048	1,257	0	-209	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: There is an increase in the number of respondents, which changes the burden estimate. Also, the annual cost to respondents for the hour burdens increased from $15.00 per hour (2010) to $23.00 per hour (2013) as stipulated by the Bureau of Labor Statistics.

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Annual Cost to Federal Government: $86,720

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: 12/30/2013

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