Request for Higher-Level Review/Supplemental Claim Application (PL 115-55) (VA Forms 20-0995 & 20-0996)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 20-0995 Request for Higher-Level Review/Supplemental Claim Application (PL 115-55) (VA Forms 20-0995 & 20-0996)	Form	Unchanged	Available
2900-0862 Supporting Statement_FINAL_1.29.19.docx	Supporting Statement A	Uploaded 2019-01-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
232032	Request for Higher-Level Review/Supplemental Claim Application (PL 115-55) (VA Forms 20-0995 & 20-0996)	Form	Unchanged

ICR Details

OMB Control No: 2900-0862	ICR Reference No: 201901-2900-005
Status: Active	Previous ICR Reference No: 201807-2900-001
Agency/Subagency: VA	Agency Tracking No: VBA-AMO-YA
Title: Request for Higher-Level Review/Supplemental Claim Application (PL 115-55) (VA Forms 20-0995 & 20-0996)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/08/2019
	Date Received in OIRA: 01/30/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2022	36 Months From Approved
Responses	115,000	0	0
Time Burden (Hours)	28,750	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Veterans Appeals Improvement and Modernization Act of 2017 (Pub. L. 115-55) made substantial adjustments to VA’s benefits claims and appeals system. Among other changes, the legislation requires that claimants have access to a new three lane decision review process. As a part of the implementation of Pub. L. 115-55, VA created an entirely new higher-level review process, along with the appropriate form for requesting a higher-level review. Information is requested by this form to formalize a request for higher-level review on a decision rendered by VA. Authority is found in Pub. L. 115-55, and proposed 38 C.F.R. § 3.2601. In addition, VA created an entirely new supplemental claim process, along with the appropriate form for submitting a supplemental claim. Information is requested by this form to formalize a request for a supplemental claim on a decision rendered by VA. Authority is found in Pub. L. 115-55, and proposed 38 C.F.R. § 3.2501. In order to effectuate the new law, VBA is requesting creation of two new information collections and assignment of a new OMB Control Number for the following forms: VA Form 20-0996, Request for Higher-Level Review, and VA Form 20-0995, Supplemental Claim Application.

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Authorizing Statute(s): US Code: 38 USC 5108 Name of Law: Supplemental claims
   PL: Pub.L. 115 - 55 2 Name of Law: Veterans Appeals Improvement and Modernization Act of 2017
   US Code: 38 USC 5104B Name of Law: Higher-level review by the agency of original jurisdiction
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AQ26	Final or interim final rulemaking	84 FR 138	01/18/2019

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

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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
Request for Higher-Level Review/Supplemental Claim Application (PL 115-55) (VA Forms 20-0995 & 20-0996)	20-0995, 20-0996	DECISION REVIEW REQUEST: SUPPLEMENTAL CLAIM ,   DECISION REVIEW REQUEST: HIGHER-LEVEL REVIEW

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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	115,000	0	0	115,000	0	0
Annual Time Burden (Hours)	28,750	0	0	28,750	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: Changing Regulations

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

Burden Reduction Due to:

Short Statement: This is a new information collection and all burden hours are considered an increase.

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Annual Cost to Federal Government: $1,921,616

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

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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: 01/30/2019

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