Expanded Access to Non-VA Care Through the Mission Act: Veterans Community Care Program (VCCP)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10-10143f 10-10143f - Community Care Document Cover Sheet	Form and Instruction	New	Available
Form 10-10143e 10-10143e Secondary Authorization Request (SAR) for VA Community Care	Form	Modified	Available
Form 10-10143a 10-10143a Health-Care Plan Information for the Veterans Choice Program	Form and Instruction	Modified	Available
30-day FRN_MISSION Act VCCP_2900-0823_published 100719.pdf	Supplementary Document	Uploaded 2020-03-27	Available
60-day FRN_MISSION Act VCCP_2900-0823_published 072219.pdf	Supplementary Document	Uploaded 2019-09-30	Available
AQ46(F) PRA Supporting Statement A_revised 2020_FINAL.docx	Supporting Statement A	Uploaded 2020-03-31	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
241051	10-10143f - Community Care Document Cover Sheet	Form and Instruction	New
221260	10-10143e Secondary Authorization Request (SAR) for VA Community Care	Form	Modified
213638	10-10143c Submission of Information on Credentials and Licenses by Eligible Entities and Providers		Modified
213637	10-10143b Submission of Medical Record Information under the Veterans Community Care Program		Modified
213636	10-10143a Health-Care Plan Information for the Veterans Choice Program	Form and Instruction	Modified
213635	10-10143 Election to Receive Authorized Non-VA Care and Selection of Provider for the Veterans Community Care Program	Other-Script	Modified

ICR Details

OMB Control No: 2900-0823	ICR Reference No: 201905-2900-007
Status: Historical Active	Previous ICR Reference No: 201604-2900-018
Agency/Subagency: VA	Agency Tracking No: 2900-0823
Title: Expanded Access to Non-VA Care Through the Mission Act: Veterans Community Care Program (VCCP)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 04/01/2020
	Date Received in OIRA: 03/31/2020
Terms of Clearance: This revision is approval pursuant to 5 CFR 1320.13.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2020	36 Months From Approved	06/30/2020
Responses	22,258,371	0	12,729,667
Time Burden (Hours)	2,924,227	0	1,786,557
Cost Burden (Dollars)	0	0	0

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Abstract: Section 101 of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 requires VA to implement the Veterans Community Care Program (VCCP) to furnish care in the community to covered Veterans through eligible entities and providers, under circumstances as further prescribed in the MISSION Act. VA currently collects information that will be required to implement the Veterans Community Care Program under the Veterans Choice Program, through an OMB approved collection 2900-0823. OMB collection 2900-0823 includes VA Form 10-10143, Election to Receive Authorized Non-VA Care and Selection of Provider for the Veterans Choice Program; VA Form 10-10143a, Health-Care Plan Information for the Veterans Choice Program; VA Form 10-10143b, Submission of Medical Record Information under the Veterans Choice Program; VA Form 10-10143c, Submission of Information on Credentials and Licenses by Eligible Entities and Providers; and VA Form 10-10143e, Secondary Authorization Request for VA Community Care. A new form also will be added to this collection: VA Form 10-10143f, Community Care Document Cover Sheet. VA seeks to update OMB collection 2900-0823 to implement the Veterans Community Care Program by updating the title of VA forms and any associated statutory citations to be consistent with the new program and the MISSION Act, and by updating burden hours to account for estimated increased use of community care under the new program.

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Authorizing Statute(s): PL: Pub.L. 115 - 182 101 Name of Law: VA MISSION Act of 2018
  

Citations for New Statutory Requirements: PL: Pub.L. 115 - 182 101 Name of Law: VA MISSION Act of 2018

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AQ46	Final or interim final rulemaking	84 FR 21668	05/14/2019

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 35181	07/22/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 53570	10/07/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
10-10143c Submission of Information on Credentials and Licenses by Eligible Entities and Providers
10-10143 Election to Receive Authorized Non-VA Care and Selection of Provider for the Veterans Community Care Program
10-10143a Health-Care Plan Information for the Veterans Choice Program	10-10143a	Health Care Plan Information for the Veterans Choice Program
10-10143f - Community Care Document Cover Sheet	10-10143f	Community Care Document Cover Sheet
10-10143b Submission of Medical Record Information under the Veterans Community Care Program
10-10143e Secondary Authorization Request (SAR) for VA Community Care	10-10143e	SAR for VA Community Care

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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	22,258,371	12,729,667	9,028,704	500,000	0	0
Annual Time Burden (Hours)	2,924,227	1,786,557	1,096,003	41,667	0	0
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: Section 101 of the MISSION Act establishes different and broader eligibility to receive care in the community than the current Veterans Choice Program. This accounts for the estimated increase in covered Veterans who will use community care under the VCCP.

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Annual Cost to Federal Government:

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: 03/31/2020

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