VA Advance Directive - Durable Power of Attorney for Health Care and Living Will [AQ97]

Forms and Documents

Document Name	Status
Form 10-0137 VA Form 10-0137 Form and Instruction	New
Memorandum_Request for Emergency PRA Clearance_VA Advance Directive_2900-0556 - (5-7-20) MS signed.docm Supporting Statement A	2020-05-07
Memorandum_Request for Emergency PRA Clearance_VA Advance Directive_2900-0556 - (5-7-20) MS signed.docm Supplementary Document	2020-05-07

IC Document Collections

IC ID	Document Title	Status
242471	VA Form 10-0137 Form and Instruction	New
241723	Close Personal Friend Statement of Relationship to Veteran	Unchanged

ICR Details

OMB Control No: 2900-0556	ICR Reference No: 202006-2900-009
Status: Active	Previous ICR Reference No: 202005-2900-003
Agency/Subagency: VA	Agency Tracking No: 2900-0556
Title: VA Advance Directive - Durable Power of Attorney for Health Care and Living Will [AQ97]
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 07/01/2020
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/07/2020
	Date Received in OIRA: 06/30/2020
Terms of Clearance: Emergency approval is granted. VA shall proceed with the normal clearance process in order to avoid a lapse in OMB approval.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2021	6 Months From Approved	12/31/2020
Responses	343,922	0	300
Time Burden (Hours)	171,861	0	50
Cost Burden (Dollars)	0	0	0

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Abstract: Section 7331 of title 38, United States Code (U.S.C.), requires, in relevant part, that the Secretary of Veterans Affairs, upon the recommendation of the Under Secretary for Health, prescribe regulations to ensure, to the maximum extent practicable, that all VA patient care be carried out only with the full and informed consent of the patient, or in appropriate cases, a representative thereof. Based on VA’s interpretation of this statute and our mandate in 38 U.S.C. 7301(b) to provide a complete medical and hospital service, we recognize that patients with decision-making capacity have the right to state their treatment preferences in a VA or other valid advance directive. The VA advance directive form (both English and Spanish language versions) is VA Form 10-0137. These forms have a current OMB Paperwork Reduction Act (PRA) clearance under OMB Control Number 2900-0556.

Emergency Justfication: This request for an emergency PRA clearance applies to changes made to the Witnesses Section of VA Form 10-0137 Advance Directive (both English and Spanish language versions). This information collection is noticed in the interim final rule associated with RIN 2900-AQ97. Emergency clearance is requested because AQ97 changed from a proposed rule to an interim final rule that will soon be cleared for publication in the Federal Register. The use of regular OMB clearance procedures will not allow for coordination of the PRA clearance with publication of the rule.

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Authorizing Statute(s): US Code: 38 USC 7331 Name of Law: Informed consent
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AQ97	Final or interim final rulemaking	85 FR 31690	05/27/2020

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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: 2

IC Title	Form No.	Form Name
Close Personal Friend Statement of Relationship to Veteran
VA Form 10-0137	10-0137, 10-0137	VA Advance Directive - Durable Power of Attorney for Health Care and Living Will ,   VA Advance Directive - Durable Power of Atttorney for Health Care and Living WIll (English-Spanish)

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ICR Summary 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	343,922	300	0	343,622	0	0
Annual Time Burden (Hours)	171,861	50	0	171,811	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: The burden for this information collection has not changed for VA Form 10-0137; however, there was an addition previously approved by OMB for an estimated 300 Close Friend Statements to be collected annually as part of 2900-0556.

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Annual Cost to Federal Government: $6,379,342

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? Yes

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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: 06/30/2020

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