EXPANDED ACCESS TO NON-VA CARE THROUGH THE VETERANS CHOICE PROGRAM, OMB 2900-AP24

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10-10143a Health Care Plan Information for the Veterans Choice Program	Form and Instruction	New	Available
Form 10-10143 Election to Receive Authorized Non-VA Care and Selection of Provider for the Veterans Choice Program Script	Form and Instruction	New	Available
Supporting Statements - v14 - Updated Estimates.docx	Supporting Statement A	Uploaded 2014-11-03	Available
Emergency Clearance Request - v2 - KLP Edits - 102714.docx	Supplementary Document	Uploaded 2014-10-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213638	10-10143c Submission of Information on Credentials and Licenses by Eligible Entities and Providers		New
213637	10-10143b Submission of Medical Record Information under the Veterans Choice Program		New
213636	10-10143a Health-Care Plan Information for the Veterans Choice Program	Form and Instruction	New	Health Care Plan Information for the Veterans Choice Program
213635	10-10143 Election to Receive Authorized Non-VA Care and Selection of Provider for the Veterans Choice Program	Form and Instruction	New	Election to Receive Authorized Non-VA Care and Selection of Provider for the Veterans Choice Program Script

ICR Details

OMB Control No: 2900-0823	ICR Reference No: 201410-2900-012
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No:
Title: EXPANDED ACCESS TO NON-VA CARE THROUGH THE VETERANS CHOICE PROGRAM, OMB 2900-AP24
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: 10/30/2014
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/05/2014
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/27/2014
Terms of Clearance: VA will seek public comment on this information collection prior to seeking an extension of this approval.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2015	6 Months From Approved
Responses	11,860,189	0	0
Time Burden (Hours)	753,846	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Veterans Access, Choice, and Accountability Act of 2014 (the Act) requires implementing measures to allow the Secretary of Veterans Affairs to improve health care for veterans who have not been seen within established wait-time goals or who experience challenges based on their place of residence. The Act directs VA to provide hospital care and medical services to eligible veterans through agreements with eligible non-VA health care entities or providers.

Emergency Justfication: Under 38 U.S.C. 501 and as authorized under the Veterans, Access, Choice, and Accountability Act of 2014 (Public Law 113-146), VA is implementing the Veterans Choice Program through an interim final rule (RIN 2900-AP24). The agency is required to implement the requirements of this law by November 5, 2014. VA requests an emergency approval on or before October 27, 2014 to properly submit this IFR to the Federal Register for posting on November 5, 2014. In order to carry out the requirements of this law, VA must collect certain information from Veterans and non-VA health care entities and providers to ensure proper application of the Program. VA cannot furnish the statutorily-mandated hospital care and medical services until the collection of information is approved. The specific hospital care and medical services that VA must provide are for eligible veterans. Some of these veterans may have life-threatening conditions that require immediate medical attention. Therefore, VA certifies that the collection of information meets each of the listed criteria for the following reasons: Data collection is needed prior to the expiration of time periods established in this part: The data being collected is needed prior to the expiration of time periods established under this part due to anticipation that the regulations authorizing the VA Choice Card Program will publish and become effective prior to the expiration of the time periods established under this Part. Data collection is essential to the mission of the agency: The collection is essential to the mission of the agency because VA cannot begin to furnish the hospital care and medical services set forth in regulation and required by law without authorization to collect the required information. The agency cannot reasonably comply with the normal clearance procedures under this Part because: VA cannot reasonably comply with the normal clearance procedures because public harm is reasonably likely to result if normal clearance procedures are followed. VA is required to furnish timely hospital care and medical services to eligible Veterans.

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Authorizing Statute(s): PL: Pub.L. 113 - 146 101 Name of Law: Veterans, Access, Choice, and Accountability Act of 2014
  

Citations for New Statutory Requirements: PL: Pub.L. 113 - 146 101 Name of Law: Veterans, Access, Choice, and Accountability Act of 2014

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AP24	Final or interim final rulemaking	12 FR 3456	10/27/2014

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
10-10143 Election to Receive Authorized Non-VA Care and Selection of Provider for the Veterans Choice Program	10-10143	Election to Receive Authorized Non-VA Care and Selection of Provider for the Veterans Choice Program Script
10-10143a Health-Care Plan Information for the Veterans Choice Program	10-10143a	Health Care Plan Information for the Veterans Choice Program
10-10143b Submission of Medical Record Information under the Veterans Choice Program
10-10143c Submission of Information on Credentials and Licenses by Eligible Entities and Providers

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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	11,860,189	0	0	11,860,189	0	0
Annual Time Burden (Hours)	753,846	0	0	753,846	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: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Burden is increased due to Public Law and related regulation.

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Annual Cost to Federal Government: $116,578

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: 10/27/2014

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