Survey of Veteran Enrollees' Health and Reliance Upon VA

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10-21034G Survey of Veteran Enrollees' Health and Reliance Upon VA	Form and Instruction	Modified	Available
Justification and Request for Expedited Review of Survey of Veteran Enro....docx	Supplementary Document	Uploaded 2016-02-01	Available
547374_FAQ_approved_012916.pdf	Supplementary Document	Uploaded 2016-01-29	Repair queued
4_Letter with first questionnaire_V3_012916.docx	Supplementary Document	Uploaded 2016-01-29	Repair queued
2a_URL letter after pre notifiction letter_v3_012916.docx	Supplementary Document	Uploaded 2016-01-29	Repair queued
Strata_popcounts_rv_012116.xls	Supplementary Document	Uploaded 2016-01-25	Available
2014 VHA Bias Report_112414.pdf	Supplementary Document	Uploaded 2016-01-25	Available
SENT_VE_Non_Substantial_Change_White Paper 12 28 15 _ Final - 1.4.16.docx	Supplementary Document	Uploaded 2016-01-14	Repair queued
Justification A 021016_FINAL.docx	Supporting Statement A	Uploaded 2016-02-10	Available
Justification_B_SOE 2015 OMB Clearance.doc	Supporting Statement B	Uploaded 2016-01-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
28855	Survey of Veteran Enrollees' Health and Reliance Upon VA	Form and Instruction	Modified

ICR Details

OMB Control No: 2900-0609	ICR Reference No: 201601-2900-011
Status: Historical Active	Previous ICR Reference No: 201212-2900-013
Agency/Subagency: VA	Agency Tracking No: 2900-0609
Title: Survey of Veteran Enrollees' Health and Reliance Upon VA
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/07/2016
	Date Received in OIRA: 02/11/2016
Terms of Clearance: A separate written authorization must be obtained by VA from OMB prior to the testing or offering of any incentives to respondents.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2019	02/29/2016	03/31/2016
Responses	42,000	0	42,080
Time Burden (Hours)	14,000	0	14,728
Cost Burden (Dollars)	0	0	0

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Abstract: Study of enrollees' health status, income, reliance on VA & interest in Prescription-Only Program will provide information for planning & policy development for actuarial projections of enrollment, utilization, expenditures, mandated annual enrollment reforms, & quantitative & qualitative research.

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Authorizing Statute(s): PL: Pub.L. 104 - 262 Entirety Name of Law: Veterans Health Care Eligibility Reform Act of 1996,
  

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:
	80 FR 72786	11/20/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 6342	02/05/2016
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
Survey of Veteran Enrollees' Health and Reliance Upon VA	10-21034G	Survey of Veteran Enrollees w/VE Questions

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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	42,000	42,080	0	-80	0	0
Annual Time Burden (Hours)	14,000	14,728	0	-728	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The burden decreased by 14,700 to 14,000 making for a 700 hour decrease.

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Annual Cost to Federal Government: $1,300,000

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: 02/11/2016

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