Yellow Ribbon Program Agreement (VA Form 22-0839)

Forms and Documents

Document Name	Status
Form 22-0839 Yellow Ribbon Program Agreement Form	Modified
Supporting Statement(2900-0718).docx Supporting Statement A	2018-06-07
2018-09054.pdf Supplementary Document	2018-06-07
2018-02507.pdf Supplementary Document	2018-02-14

IC Document Collections

IC ID	Document Title	Status
187009	Yellow Ribbon Program Agreement Form	Modified

ICR Details

OMB Control No: 2900-0718	ICR Reference No: 201801-2900-015
Status: Historical Inactive	Previous ICR Reference No: 201409-2900-017
Agency/Subagency: VA	Agency Tracking No: VBA-EDU-DJ/NK
Title: Yellow Ribbon Program Agreement (VA Form 22-0839)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn	Conclusion Date: 09/20/2018
	Date Received in OIRA: 06/08/2018
Terms of Clearance: Agency will re-submit as a re-instatement w/o change.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The VA Form 22-0839 will be used by institutions of higher learning (IHLs) to request participation in the Yellow Ribbon Program and provide details of the manner in which the IHL will participate.

---

Authorizing Statute(s): US Code: 38 USC 3317 Name of Law: Public - Private Contribution for Addtional Educational Assistance
   PL: Pub.L. 110 - 252 5003 Name of Law: EDUCATIONAL ASSISTANCE AUTHORIZED
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 2507	02/07/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 9054	04/30/2018
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Yellow Ribbon Program Agreement	22-0839	Yellow Ribbon Program Agreement

---

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: The increase in the annual reporting burden is due the increase in the number of schools submitting the Yellow Ribbon Program Agreement.

---

Annual Cost to Federal Government: $86,795

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.     Yes

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.     Yes

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

---

Common Form ICR:  No

---

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: 06/08/2018

---