VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Programs

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VA Form 10-0491L VIOMPSP Agreement	Form	Modified	Available
Form VA Form 10-0491k HPSP/VIOMPSP VA Scholarship Offer Response	Form	Modified	Available
Form VA Form 10-0491j HPSP/VIOMPSP Request for Deferment for Advanced Education	Form	Modified	Available
Form VA Form 10-0491i HPSP/VIOMPSP Notice of Change and/or Annual Academic Status Report	Form	Modified	Available
Form VA Form 10-0491h HPSP/VIOMPSP Notice of Approaching Graduation	Form	Modified	Available
Form VA Form 10-0491g HPSP/VIOMPSP Application	Form and Instruction	Modified	Available
Form VA Form 10-0491f HPSP Agreement	Form	Modified	Available
Form VA Form 10-0491e HPSP/VIOMPSP Evaluation Recommendation Form	Form	Modified	Available
Form VA Form 10-0491d HPSP/VIOMPSP Education Program Completion Notice_Service Obligation Placement	Form	Modified	Available
Form VA Form 10-0491c HPSP/VIOMPSP Annual VA employment deferment Verification	Form	Modified	Available
Form VA Form 10-0491a HPSP/VIOMPSP Addendum to Application	Form	Modified	Available
Form VA form 10-0491 HPSP/VIOMPSP Academic Verification	Form	Modified	Available
2900-0793 Justification _clean VA.docx	Supporting Statement A	Uploaded 2017-06-13	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
204870	VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form	Modified	VIOMPSP Agreement
204870	VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form	Modified	HPSP/VIOMPSP VA Scholarship Offer Response
204870	VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form	Modified	HPSP/VIOMPSP Request for Deferment for Advanced Education
204870	VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form	Modified	HPSP/VIOMPSP Notice of Change and/or Annual Academic Status Report
204870	VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form	Modified	HPSP/VIOMPSP Notice of Approaching Graduation
204870	VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form and Instruction	Modified	HPSP/VIOMPSP Application
204870	VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form	Modified	HPSP Agreement
204870	VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form	Modified	HPSP/VIOMPSP Evaluation Recommendation Form
204870	VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form	Modified	HPSP/VIOMPSP Education Program Completion Notice_Service Obligation Placement
204870	VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form	Modified	HPSP/VIOMPSP Annual VA employment deferment Verification
204870	VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form	Modified	HPSP/VIOMPSP Addendum to Application
204870	VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	Form	Modified	HPSP/VIOMPSP Academic Verification

ICR Details

OMB Control No: 2900-0793	ICR Reference No: 201604-2900-017
Status: Historical Active	Previous ICR Reference No: 201306-2900-007
Agency/Subagency: VA	Agency Tracking No: 2900-0793
Title: VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Programs
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/14/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/14/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2020	36 Months From Approved	06/30/2017
Responses	6,500	0	6,500
Time Burden (Hours)	24,342	0	32,689
Cost Burden (Dollars)	0	0	0

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Abstract: A collection of information is necessary to implement the Department of Veterans Affairs Visual Impairment and Orientation and Mobility Professionals Scholarship Program and the VA Health Professional Scholarship Program authorized under Public Law 111-163. This legislation allows VA to provide services to the public by awarding scholarships to non-VA employees who will be required to become VA employees in the professions for which they were educated under these programs. These programs will help address VA health care workforce needs.

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Authorizing Statute(s): PL: Pub.L. 111 - 163 302 Name of Law: Caregivers and Veterans Omnibus Health Services act of 2010
   US Code: 38 USC Part 1, Chapter 5, Section 527 Name of Law: Measurement and Evaluation of DVA Programs
  

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:
	81 FR 69904	10/07/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 89576	12/12/2016
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
VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Pr	VA form 10-0491, VA Form 10-0491a, VA Form 10-0491c, VA Form 10-0491d, VA Form 10-0491e, VA Form 10-0491f, VA Form 10-0491g, VA Form 10-0491h, VA Form 10-0491i, VA Form 10-0491j, VA Form 10-0491k, VA Form 10-0491L	HPSP/VIOMPSP Academic Verification ,   HPSP/VIOMPSP Addendum to Application ,   HPSP/VIOMPSP Annual VA employment deferment Verification ,   HPSP/VIOMPSP Education Program Completion Notice_Service Obligation Placement ,   HPSP/VIOMPSP Evaluation Recommendation Form ,   HPSP Agreement ,   HPSP/VIOMPSP Application ,   HPSP/VIOMPSP Notice of Approaching Graduation ,   HPSP/VIOMPSP Notice of Change and/or Annual Academic Status Report ,   HPSP/VIOMPSP Request for Deferment for Advanced Education ,   HPSP/VIOMPSP VA Scholarship Offer Response ,   VIOMPSP Agreement

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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	6,500	6,500	0	0	0	0
Annual Time Burden (Hours)	24,342	32,689	0	0	-8,347	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: Changes were made to the Annual Burden Hour to match the justification statement.

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Annual Cost to Federal Government: $4,911,000

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: 12/14/2016

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