Veterans Employment Pay For Success (VEPFS), Grant Program Application

Forms and Documents

Document Name	Status
Form VA Form 10193 VA Form 10193 VEPFS Application Form and Instruction	New
Standard Form 424.pdf Supplementary Document	2016-08-09
VBA-26-0967a.pdf Supplementary Document	2016-08-09
VBA-26-0967.pdf Supplementary Document	2016-08-09
Emergency Request Memo-VEPFS Interim Final Rule AP72 (003) 882016.docx Supplementary Document	2016-08-09
Blank White Paper.docx Supplementary Document	2016-08-09
PRA JUSTIFICATION VEPFS 20160802.doc Supporting Statement A	2016-08-09

IC Document Collections

IC ID	Document Title	Status
222913	38 CFR 21.447(a)(1) and 21.448(a) Quarterly Fiscal Compliance Reports	New
222393	VA Form 10193 VEPFS Application Form and Instruction	New

ICR Details

OMB Control No: 2900-0847	ICR Reference No: 201607-2900-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No:
Title: Veterans Employment Pay For Success (VEPFS), Grant Program Application
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: 10/11/2016
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/09/2016
	Date Received in OIRA: 08/09/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2017	6 Months From Approved
Responses	65	0	0
Time Burden (Hours)	2,040	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 3119 of title 38, United States Code, authorizes the Secretary of Veterans Affairs to make grants to or contract with public or nonprofit agencies, including institutions of higher learning, to advance “the knowledge, methods, techniques, and resources available for use in rehabilitation programs for veterans.” Section 3119 specifically authorizes the Secretary to make grants to such agencies to conduct or provide support for projects which are “designed to increase the resources and potential for accomplishing the rehabilitation of disabled veterans.” VA has codified these provisions in its regulations at 38 CFR 21.390 Rehabilitation research and special projects. The purpose of the VEPFS program is to provide one or more grants to fund Outcomes Payments for one or more PFS projects that seek to improve employment outcomes for Veterans with a Service-connected Mental Health Disability.

Emergency Justfication: VA is submitting a request for Emergency Clearance for the PRA package related to the Interim Final Rule AP72, “Veterans Employment Pay for Success Program,” which published in the Federal Register on August 10, 2016 (2016-18721). The rule published as Interim Final without a prior Proposed rule, as approved by OIRA. This PRA action therefore requires submission to OIRA via an emergency clearance.

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Authorizing Statute(s): US Code: 38 USC 3119 Name of Law: Rehabilitation Research and Special Projects
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AP72	Final or interim final rulemaking	81 FR 11111	08/09/2016

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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: 2

IC Title	Form No.	Form Name
VA Form 10193 VEPFS Application	VA Form 10193	Veterans Employment Pay for Success (VEPFS) Grant Application
38 CFR 21.447(a)(1) and 21.448(a) Quarterly Fiscal Compliance Reports

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ICR Summary 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	65	0	0	65	0	0
Annual Time Burden (Hours)	2,040	0	0	2,040	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: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a new data collection request, therefore, all hours are considered a burden increase.

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Annual Cost to Federal Government: $6,043

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: 08/09/2016

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