VA National Rehabilitation Special Events Forms

Forms and Documents

Document Name	Status
Form 0927a VA National Rehabilitation Special Events Form	Modified
Justification 2900-0759 SS (14APR14).doc Supporting Statement A	2014-04-14

IC Document Collections

IC ID	Document Title	Status
193170	VA National Rehabilitation Special Events Form	Modified

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
	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.

	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

---

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.

---

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

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

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

---

Number of Information Collection (IC) in this ICR: 1

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 Veterans Tee Tournament, Registration Check List ,   Participant Registration Form-Physical Exam, National Veterans Tee Tournament ,   Surfing Personnel Application, National Veterans Summer Sports Clinic ,   Venue Personnel Application, National Veterans Summer Sports Clinic ,   Participant Registration Application, National Veterans Creative Arts Festival ,   National Disabled Veterans Winter Sports Clinic, Registration Check List ,   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 ,   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 ,   Athlete Application, National Veterans Golden Age Games ,   General Medical Form ,   Voluntary Service Application, National Veterans Wheelchair Games ,   General Medical/Physical Exam Form, National Veterans Summer Sports Clinic ,   Volunteer Application, National Veterans Summer Sports Clinic ,   National Veterans Golden Age Games, Registration Check List ,   National Veterans Creative Arts Festival, Participant Registration Check List ,   Participant Medical Information, National Veterans Creative Arts Festival ,   National Veterans Summer Sports Clinic, Registration Check List ,   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 ,   General Ski Information, National Disabled Veterans Winter Sport Clinic ,   General Medical/Physical Exam Form, National Disabled Veterans Winter Sport Clinic ,   Volunteer Application, National Veterans Golden Age Games ,   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

---

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	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.

---

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

---

Common Form ICR:  No

---

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

---