Principles of Excellence Complaint Intake Questionnaire

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VA Form 22-0959 Principles of Excellence Complaint Intake Questionnaire	Form	New	Repair queued
22-0959(5-13) (3).pdf	Supplementary Document	Uploaded 2013-05-20	Repair queued
Changes to VA Form 22-0959 - Adobe Acrobat.pdf	Supplementary Document	Uploaded 2013-05-14	Repair queued
PoE Complaint Intake Questionnaire SS.doc	Supporting Statement A	Uploaded 2013-06-05	Repair queued
Eemergency Justification - PoE Complaint Intake Questionnaire.doc	Supplementary Document	Uploaded 2013-04-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
206726	Principles of Excellence Complaint Intake Questionnaire	Form	New

ICR Details

OMB Control No:	ICR Reference No: 201304-2900-036
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No: 2900-NEW VBA-EDU-NK
Title: Principles of Excellence Complaint Intake Questionnaire
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 05/30/2013
OIRA Conclusion Action: Withdrawn	Conclusion Date: 08/23/2013
	Date Received in OIRA: 05/01/2013
Terms of Clearance: VA has requested a withdrawal of this emergency request and will instead publish a Federal Register notice seeking comment on an electronic complaint system instead prior to its next submission to OMB.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		6 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Executive Order 13607, Establishing Principles of Excellence for Educational Institutions Serving Service Members, Veterans, Spouses, and Other Family Members, requires the establishment of a centralized complaint system for VA, DoD, and Department of Education. The purpose of the centralized complaint system is to provide a standardized method for beneficiaries and others to submit a complaint or allegation that an entity or individual has not or may not have adhered to the principles of excellence established in the Executive Order. The Complaint Intake Form will enable VA to identify the entity or individual not in compliance with the Principles of Excellence and to assess the complaints of noncompliance. Assessment of compliance will include identifying areas we can improve to ensure adherence to the Principles of Excellence.

Emergency Justfication: The Department of the Veterans Affairs (VA) respectfully requests emergency processing and approval of the collection of information for the Principles of Excellence Complaint Intake Questionnaire (VA Form 22-0959) because normal clearance procedures are reasonably likely to cause a further delay in the receipt and processing of complaints about educational institutions as mandated by Executive Order 13607 - Establishing Principles of Excellence for Educational Institutions Serving Service Members, Veterans, Spouses, and Other Family Members, signed by President Barack Obama on April 27, 2012. The Executive Order was issued to address the problem of aggressive and deceptive targeting of individuals in receipt of military and Veterans benefits by some educational institutions. Specifically, section 4 of the Executive Order directs the Secretaries of Defense and Veterans Affairs, in consultation with the Secretary of Education, the Director of the Consumer Finance Protection Bureau (CFPB), and the Attorney General, to create a robust complaint process for students receiving Federal military and Veterans educational benefits. The Executive Order required that these Federal Agencies report the progress of this complaint process to the White House 90 days following the date of this order. Due to the complex automation issues and multiple Federal agency-specific procedures involved with coordinating a system of this magnitude, we have already missed the January 2013 deadline to begin accepting and processing complaints. This collection of information required the creation of a new system of records. The system of records, entitled Principles of Excellence Centralized Complaint System - VA 170VA22, was effective on March 25, 2013. Due to the time involved in the creation and approval of this new system of records, VA did not meet the original implementation timeline. Although VA has published the list of institutions that have agreed to adhere to the Principles of Excellence, we have no authority to collect complaints/feedback on these institutions to help ensure that are not out of compliance with the Executive Order. To eliminate any further delay and to meet the June 1, 2013 timeline to accept complaints, VA must have the information collection approved by May 17, 2013. This will allow VA time to publish the form on the web, notify Veterans, State Approving Agencies, Veteran Service Organizations, educational institutions, and issue guidance to our field offices.

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Authorizing Statute(s): EO: EO 13607 Name/Subject of EO: Principles of Excellence
  

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
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 83	04/30/2013
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
Principles of Excellence Complaint Intake Questionnaire	VA Form 22-0959	Principles of Excellence Complaint Intake Questionnaire

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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 information collection.

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Annual Cost to Federal Government: $25,596

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: 05/01/2013

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