Airborne Hazards and Open Burn Pit Registry (AHOBPR) Web-accessible Self-Assessment/Questionnaire (VA Form 10-10066)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10-10066 AHOBPR Questionnaire - Qarmat Ali Sub-population Follow-up	Form and Instruction	New	Repair queued
Form 10-10066 Airborne Hazards and Open Burn Pit Registry Self-Assessment Questionnaire	Form and Instruction	New	Repair queued
Form 10-10066 Airborne Hazard and Open Burn Pit Registry Self-Assessment Questionnaire	Form and Instruction	New	Repair queued
Form VA Form 10-10066 Airborne Hazards And Open Burn Pit Registry Self-Assessment Questionnaire	Form	Removed	Repair queued
Form VA Form 10-10066 Airborne Hazards And Open Burn Pit Registry Self-Assessment Questionnaire	Form	Removed	Repair queued
30-day FRN_AHOBPR_published 07252019.pdf	Supplementary Document	Uploaded 2019-08-13	Repair queued
60-day FRN_AHOBPR_published 05062019.pdf	Supplementary Document	Uploaded 2019-08-13	Repair queued
Justification Statement Part A_AHOBPR Self Assessment_Renewal_FINAL revised _August 2019.docx	Supporting Statement A	Uploaded 2019-08-13	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
248528	AHOBPR - Medical Examinations	Other-Exam Template	New
248526	Focus Groups for AHOBPR - Discussion Guide	Other-Discussion Guide	New
248524	Focus Groups for AHOBPR - Recruitment Screener Script	Other-Script	New
235614	AHOBPR Questionnaire - Qarmat Ali Sub-population Follow-up	Form and Instruction	New
235161	Airborne Hazard and Open Burn Pit Registry Self-Assessment Questionnaire	Form and Instruction	New	Airborne Hazards and Open Burn Pit Registry Self-Assessment Questionnaire
235161	Airborne Hazard and Open Burn Pit Registry Self-Assessment Questionnaire	Form and Instruction	New
210929	Airborne Hazards And Open Burn Pit Registry Self-Assessment Questionnaire	Form	Removed	Airborne Hazards And Open Burn Pit Registry Self-Assessment Questionnaire
210929	Airborne Hazards And Open Burn Pit Registry Self-Assessment Questionnaire	Form	Removed

ICR Details

OMB Control No: 2900-0800	ICR Reference No: 201903-2900-001
Status: Historical Active	Previous ICR Reference No: 201401-2900-002
Agency/Subagency: VA	Agency Tracking No: 2900-0800
Title: Airborne Hazards and Open Burn Pit Registry (AHOBPR) Web-accessible Self-Assessment/Questionnaire (VA Form 10-10066)
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 with change	Conclusion Date: 08/03/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 08/13/2019
Terms of Clearance: We appreciate VA’s agreement to provide in the next review submission an Appendix with a detailed set of tables explaining the composition of the respondent population and comparing it to the broader population of deployed and potentially exposed veterans (participating and non-participating), by branch of armed service and exposure cohort. VA will use its 2015 Report on Data from the Airborne Hazards and Open Burn Pit Registry as a starting point for this Appendix.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2024	36 Months From Approved	03/31/2017
Responses	70,162	0	50,000
Time Burden (Hours)	39,720	0	33,333
Cost Burden (Dollars)	0	0	0

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Abstract: Public Law 112-260 Section 201, enacted by President Obama on 10 January 2013, required Department of Veterans Affairs (VA) to establish and maintain an “Airborne Hazards and Open Burn Pit Registry (AHOBPR)” no later than one year from enactment. VA launched the AHOBPR in June 2014. There is no sunset date identified in the law. The Secretary of Veterans Affairs may “include any information in such registry that the Secretary of Veterans Affairs determines necessary to ascertain and monitor the health effects of the exposure of members of the Armed Forces to toxic airborne chemicals and fumes caused by open burn pits.” Currently, VA plans to operate the AHOBPR indefinitely, and we request approval to continue administering the questionnaire. Individuals eligible for the registry include members of the Armed Forces who may have been exposed to burn pit emissions or other potential airborne environmental hazards while deployed to the Southwest Asia theater of operations (Iraq, Kuwait, Saudi Arabia, Bahrain, Qatar, the United Arab Emirates, Oman, Gulf of Aden, Gulf of Oman, waters of the Persian Gulf, the Arabian Sea, and the Red Sea) on or after August 2, 1990 (as defined in 38 CFR 3.317(e)(2)), or Afghanistan or Djibouti, Africa on or after September 11, 2001. Focus groups are a solution to get answers to recommendations that were recommended by the National Academy of Sciences Engineering and Medicine (NASEM, 2017) to evaluate whether and how registrants who did not complete the questionnaire differ from those who did, analyze the determinants of non-completion, and use this information to formulate strategies to encourage registrants to finish and submit their responses and improve the completion rate for future participants. Information collected is voluntary and is used to provide outreach and quality health services to AHOBPR participants. Collected data contributes to VA’s ability to understand the potential health effects of the exposure to burn pit emissions and other airborne hazards during deployment, such as particulate matter.

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Authorizing Statute(s): PL: Pub.L. 112 - 260 201 Name of Law: Establishment of Open Burn Pit Registry
  

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:
	84 FR 19829	05/06/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 35930	07/25/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
AHOBPR - Medical Examinations
Airborne Hazard and Open Burn Pit Registry Self-Assessment Questionnaire	10-10066	Airborne Hazards and Open Burn Pit Registry Self-Assessment Questionnaire
Airborne Hazards And Open Burn Pit Registry Self-Assessment Questionnaire	VA Form 10-10066	Airborne Hazards And Open Burn Pit Registry Self-Assessment Questionnaire
Focus Groups for AHOBPR - Discussion Guide
Focus Groups for AHOBPR - Recruitment Screener Script

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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	70,162	50,000	0	70,162	-50,000	0
Annual Time Burden (Hours)	39,720	33,333	0	39,720	-33,333	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: The AHOBPR Focus Groups have been added to this collection, along with the AHOBPR Questionnaire (VA Form 10-10066) and voluntary medical examinations for participants in the registry.

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Annual Cost to Federal Government: $3,751,059

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? No

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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: 08/13/2019

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