Expanded Access to Non-VA Care through the MISSION Program: Establishing a Process for Certification, Discontinuance, and Disputes for Veterans Care Agreements (VCAs) - AQ45

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
AQ45_VCA Process_Emergency Clearance Request Memo_SES Signature_08.29.19.pdf	Supplementary Document	Uploaded 2019-08-29	Available
AQ45(IF) CLEAN PRA Supporting Statement with VA responses to OMB's passback 4 (5-7-19).docx	Supporting Statement A	Uploaded 2019-08-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
235326	Provider Dispute Notice		New
235325	Discontinuation Notice for Provider		New
235324	Certification of Provider Licensure		New

ICR Details

OMB Control No: 2900-0872	ICR Reference No: 201903-2900-022
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No: 2900-NEW
Title: Expanded Access to Non-VA Care through the MISSION Program: Establishing a Process for Certification, Discontinuance, and Disputes for Veterans Care Agreements (VCAs) - AQ45
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: 09/19/2019
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/30/2019
	Date Received in OIRA: 08/30/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/29/2020	6 Months From Approved
Responses	16,107	0	0
Time Burden (Hours)	1,556	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 102 of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 authorizes VA to enter into Veterans Care Agreements (VCAs) to furnish required care and services when such care and services are not feasibly available to certain individuals through a VA facility, a contract, or a sharing agreement. VA seeks to establish a new collection to implement three requirements under section 102 of the MISSION Act: a. Certification: Eligible entities and providers will be required to submit to VA information concerning relevant credentials, licenses, and other information as requested by VA to evaluate eligibility for certification. The information to be collected is authorized by 38 U.S.C. 1703A(c). b. Discontinuation: Eligible entities and providers would be required to submit to VA a written notice of intent to discontinue a Veterans Care Agreement prior to the date of such discontinuation. The information to be collected is authorized by 38 U.S.C. 1703A(f)(1). c. Disputes: Eligible entities and providers would be required to submit to VA written notices of dispute that contain specific information to allow VA to assess and resolve the matter in dispute. The information to be collected is authorized by 38 U.S.C. 1703A(h).

Emergency Justfication: VA is seeking a 6-month emergency approval to establish a new collection to implement three requirements under section 102 of the MISSION Act: Provider Certification, Discontinuation, and Disputes.

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Authorizing Statute(s): US Code: 38 USC 1703A Name of Law: Veterans Benefits
   PL: Pub.L. 115 - 182 102 Name of Law: Veterans Care Agreements
  

Citations for New Statutory Requirements: US Code: 38 USC 1703A Name of Law: MISSION Act - Section 102

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AQ45	Final or interim final rulemaking	84 FR 21668	05/14/2019

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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: 3

table that charts list of burden

IC Title	Form No.	Form Name
Discontinuation Notice for Provider
Certification of Provider Licensure
Provider Dispute Notice

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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	16,107	0	0	16,107	0	0
Annual Time Burden (Hours)	1,556	0	0	1,556	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: Section 102 of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 authorizes VA to enter into Veterans Care Agreements (VCAs) to furnish required care and services when such care and services are not feasibly available to certain individuals through a VA facility, a contract, or a sharing agreement. VA is establishing a new collection to implement three requirements under section 102 of the MISSION Act: Provider certification, discontinuance, and disputes.

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Annual Cost to Federal Government: $105,110

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: 08/30/2019

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