VA National Veterans Sports Programs and Special Events

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Web Survey: VA For National Veterans Wheelchair Games (NVWG)	Form	New	Available
Form Web Survey: VA For National Veterans TEE Tournament (NVTEE)	Form	New	Available
Form Web Survey: VA For National Veterans Summer Sports Clinic (NVSSC)	Form	New	Available
Form Web Survey: VA For National Veterans Golden Age Games (NVGAG)	Form	New	Available
Form Web Survey: VA For National Veterans Creative Arts Festival (NVCAF)	Form	New	Repair queued
Form Web Survey: VA For National Disabled Veterans Winter Sports Clinic (NDVWSC)	Form	New	Available
NVSPSE Survey Justification B (v3).doc	Supporting Statement B	Uploaded 2014-06-19	Available
NVSPSE Survey Justification A (v5).doc	Supporting Statement A	Uploaded 2014-06-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
209677	VA National Veterans Sports Programs and Special Events Surveys	Form	New	National Veterans Wheelchair Games (NVWG)
209677	VA National Veterans Sports Programs and Special Events Surveys	Form	New	National Veterans TEE Tournament (NVTEE)
209677	VA National Veterans Sports Programs and Special Events Surveys	Form	New	National Veterans Summer Sports Clinic (NVSSC)
209677	VA National Veterans Sports Programs and Special Events Surveys	Form	New	National Veterans Golden Age Games (NVGAG)
209677	VA National Veterans Sports Programs and Special Events Surveys	Form	New	National Veterans Creative Arts Festival (NVCAF)
209677	VA National Veterans Sports Programs and Special Events Surveys	Form	New	National Disabled Veterans Winter Sports Clinic (NDVWSC)

ICR Details

OMB Control No: 2900-0818	ICR Reference No: 201312-2900-011
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No:
Title: VA National Veterans Sports Programs and Special Events
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: 07/03/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/01/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2017	36 Months From Approved
Responses	4,550	0	0
Time Burden (Hours)	193	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Department of Veterans Affairs (VA) administers National Rehabilitation Special Events for Veterans who are receiving care at VA medical facilities. 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. The surveys are designed to allow program improvement and measure the tangible, quantifiable benefits of the events using event applications. Information collected on these applications is used for the planning, distribution and utilization of resources and to allocate clinical and administrative support to patient treatment services.

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Authorizing Statute(s): US Code: 38 USC Part 1, Chapter 5, Section 527 Name of Law: Evaluation and Data Collection
  

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 245	12/20/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 47	03/11/2014
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 Veterans Sports Programs and Special Events Surveys	Web Survey: VA Form 10110, Web Survey: VA Form 10111, Web Survey: VA Form 10112, Web Survey: VA Form 10107, Web Survey: VA Form 10108, Web Survey: VA Form 10109	National Disabled Veterans Winter Sports Clinic (NDVWSC) ,   National Veterans Creative Arts Festival (NVCAF) ,   National Veterans Golden Age Games (NVGAG) ,   National Veterans Summer Sports Clinic (NVSSC) ,   National Veterans TEE Tournament (NVTEE) ,   National Veterans Wheelchair Games (NVWG)

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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	4,550	0	0	4,550	0	0
Annual Time Burden (Hours)	193	0	0	193	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 data collection. All burden hours are considered an increase.

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Annual Cost to Federal Government: $300

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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: 04/01/2014

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