Non-Substative White Paper 10-10-2014

Date: September 26, 2014

From: VHA PRA Compliance Liaison (10B4)

Subj: Automation of the VA form 10-10EZ form using Vonapp Direct Connect (VDC)

To: VA Desk Officer, Office of Management & Budget (OMB)

Cc: VA Clearance Officer, Crystal Rennie (OI&T)

Veterans Health Administration wants to add an intelligent navigation at the end of the Vonapp Direct Connect (VDC) that would populate a VA form 10-10EZ, 2900-0091. VDC is an online self-service interface that allows the veteran to complete one integrated interview process which may complete a handful of VA forms depending on the responses. The intelligent navigation would take applicable information collected and pre-fill the 10-10EZ.

The intelligent navigation process determines if the user is not currently enrolled in VA Healthcare. Once determination is made the applicant would be prompted with the below.

“ By submitting this claim, you authorize VA to seek healthcare enrollment on your behalf (in the event you are not currently enrolled in VHA). If you do not wish for VA to use the information for healthcare enrollment, please un-check this box.”

If you check the above box and are enrolled you are agreeing to pay the applicable VA copays for treatment or services of your NSC conditions as required by law. You also agree to receive communications from VA to your supplied email or mobile number.

Click to expand/ Hover to see the Paperwork Reduction Act and Privacy statement for the VA form 10-10EZ.

The Paperwork Reduction Act and Privacy statement for the VA form 10-10EZ would be available on the same page. Once, the applicant has completed the interview a VA form 10-10EZ would be automatically submitted. We do not believe this will increase the burden. The check box is making the process simpler for applicants currently identified in VA’s burden hours for each form.

The automation of this check box is using a contract that is on a very short timeline. We would appreciate a determination from OMB.