Cooperative Studies Program (CSP): Site Survey and Meeting Evaluation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10-0511 Cooperative Studies Program (CSP) Site Survey and Meeting Evaluationi	Form	Removed	Available
Form 10-10074a VA Cooperative Studies Program (CSP) Meeting Evaluation	Form and Instruction	Unchanged	Available
Form 10-10074 VA Cooperative Studies Program (CSP) Customer Satisfaction Survey	Form and Instruction	Unchanged	Available
Change request VA Form 10-10074.docx	Supplementary Document	Uploaded 2015-08-05	Available
2900-0772 White Paper.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-05-13	Available
CSP_Survey Justification A_20150722.docx	Supporting Statement A	Uploaded 2015-07-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
211083	Cooperative Studies Program (CSP) Site Survey and Meeting Evaluationi	Form	Removed
211037	VA Cooperative Studies Program (CSP) Meeting Evaluation	Form and Instruction	Unchanged
211036	VA Cooperative Studies Program (CSP) Customer Satisfaction Survey	Form and Instruction	Unchanged

ICR Details

OMB Control No: 2900-0772	ICR Reference No: 201505-2900-005
Status: Historical Active	Previous ICR Reference No: 201403-2900-014
Agency/Subagency: VA	Agency Tracking No:
Title: Cooperative Studies Program (CSP): Site Survey and Meeting Evaluation
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/17/2015
	Date Received in OIRA: 05/19/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2017	10/31/2017	10/31/2017
Responses	1,000	0	1,500
Time Burden (Hours)	166	0	166
Cost Burden (Dollars)	0	0	0

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Abstract: The information collected will be used by VA Cooperative Studies Program (CSP) leadership to evaluate their Coordinating Centers' effectiveness in conducting meetings and interacting with participating study sites and other customers.

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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:
	79 FR 3269	01/17/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 21517	04/16/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
VA Cooperative Studies Program (CSP) Customer Satisfaction Survey	10-10074	CSP Customer Satisfaction Survey
VA Cooperative Studies Program (CSP) Meeting Evaluation	10-10074a	CSP Meeting Evaluation
Cooperative Studies Program (CSP) Site Survey and Meeting Evaluationi	10-0511, 10-0511A	Cooperative Studies Program (CSP) Site Survey ,   Cooperative Studies Program (CSP) Meeting Evaluation

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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	1,000	1,500	0	0	-500	0
Annual Time Burden (Hours)	166	166	0	0	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $3,600

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: 05/19/2015

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