Community Residential Care Record Keeping

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
2900-0491 Reinstatement PRA Justification 5-18-17rev.docx	Supporting Statement A	Uploaded 2018-02-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
148312	Community Residential Care Record Keeping		Modified

ICR Details

OMB Control No: 2900-0491	ICR Reference No: 201704-2900-009
Status: Active	Previous ICR Reference No: 198804-2900-002
Agency/Subagency: VA	Agency Tracking No: 2900-0491
Title: Community Residential Care Record Keeping
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/27/2018
	Date Received in OIRA: 02/15/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2021	36 Months From Approved
Responses	730	0	0
Time Burden (Hours)	1,095	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This requirement states that Community Residential Care Facilities maintain a record for each Veteran which contains a copy of the plan of care, emergency notification procedures, and a copy of all signed agreements with the resident.

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Authorizing Statute(s): None

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:
	82 FR 27332	06/14/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 52971	11/15/2017
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
Community Residential Care Record Keeping

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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	730	0	0	-2,270	0	3,000
Annual Time Burden (Hours)	1,095	0	0	765	0	330
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: Information collection related to the CRC recordkeeping requirement was approved by OMB under OMB control number 2900-0491. This information collection approval expired on July 31, 1990, and was never renewed. However, the recordkeeping requirement continues to be part of the CRC standards, and VA continues to include access and review of those records as an integral part of the CRC inspection process. VA is now requesting reinstatement of the previously approved information collection under control number 2900-0491. The one time per year response estimate remains valid, as the CRC is required to collect this information only one time per year. Burden hours are 0.11 per response. However, the number of estimated respondents has decreased significantly since the original ICR was approved.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 02/15/2018

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