Reimbursement of Adoption Expenses for Certain Veterans, VA Form 10-10152

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10-10152 Reimbursement of Adoption Expenses for Certain Veterans	Form	Modified	Available
30-day FRN_Reinbursement for Adoption Expenses for Qualified Veterans_VA Form 10-10152_07302019.pdf	Supplementary Document	Uploaded 2019-08-20	Available
60-day FRN_Reinbursement for Adoption Expenses for Qualified Veterans_VA Form 10-10152_05242019.pdf	Supplementary Document	Uploaded 2019-08-20	Available
Reimbursement of Adoption Expenses for Certain Veterans_Supporting Statement A_Final 2019.docx	Supporting Statement A	Uploaded 2019-08-20	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
226992	Reimbursement of Adoption Expenses for Certain Veterans	Form	Modified

ICR Details

OMB Control No: 2900-0860	ICR Reference No: 201903-2900-032
Status: Active	Previous ICR Reference No: 201705-2900-010
Agency/Subagency: VA	Agency Tracking No: 2900-0860
Title: Reimbursement of Adoption Expenses for Certain Veterans, VA Form 10-10152
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/10/2020
	Date Received in OIRA: 08/22/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2023	36 Months From Approved
Responses	80	0	0
Time Burden (Hours)	480	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Section 260 of the Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2017, and Zika Response and Preparedness Act (Public Law 114-223) states that VA may use appropriated funds available to VA for the Medical Services account to provide, among other things, reimbursement of adoption expenses to a covered Veteran. “Covered Veteran” means a Veteran who has a service-connected disability that results in the inability of the Veteran to procreate without the use of fertility treatment. The term “adoption reimbursement” is defined at P. Law 114-223 section 260(a)(4) to mean reimbursement for the adoption-related expenses for an adoption that is finalized after the date of the enactment of the Act under the same terms as apply under the adoption reimbursement program of the Department of Defense, as authorized in Department of Defense Instruction 1341.09, including the reimbursement limits and requirements set forth in such instruction. This law was enacted on September 29, 2016, and funding for the program is authorized through September 30, 2018. VA’s authority to provide reimbursement of qualifying adoption expenses to the same cohort described in P. Law 114-223 section 260 was subsequently renewed and extended in nearly identical form in section 236 of Division J, Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2018, Public Law 115-141 (March 23, 2018) (the “2018 Act”). Under this most recent authority, VA’s adoption expense reimbursement program remains subject to the funding period covered by the 2018 Act and the availability of appropriations. To implement this benefit, VA has developed VA Form 10-10152, paralleling DD 2675, which requires any Veteran requesting reimbursement of qualifying adoption expenses to submit the same types of evidence as required under the DoD policy, as mandated by P. Law 114-223 section 260. VA Form 10-10152 was previously approved by OMB through the PRA clearance process, and VA now seeks an extension of that approval of this information collection.

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Authorizing Statute(s): PL: Pub.L. 114 - 223 260 Name of Law: Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropri
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AQ01	Final or interim final rulemaking	83 FR 9208	03/05/2018

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 24201	05/24/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 37016	07/30/2019
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
Reimbursement of Adoption Expenses for Certain Veterans	10-10152	Reimbursement Request for Qualifying Adoption Expenses

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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	80	0	0	0	0	80
Annual Time Burden (Hours)	480	0	0	0	0	480
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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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.     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:  Yes

Description/Changes for Common Form Usage: 

Approved RCFs using this ICR

table that charts list of RCF

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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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: 08/22/2019

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