Request for Supplies (Chapter 31 - Vocational Rehabilitation) (VA Form 28-1905m)

Forms and Documents

Document Name	Status
Form 28-1905m Request for Supplies (Chapter 31 - Vocational Rehabilitation) (VA Form 28-1905m) Form	Modified
30 Day FRN.pdf Supplementary Document	2021-06-23
28-1905m supporting statement.DOC.docx Supporting Statement A	2021-06-10
2900-0061_60-Day FRN.pdf Supplementary Document	2021-05-04

IC Document Collections

IC ID	Document Title	Status
28199	Request for Supplies (Chapter 31 - Vocational Rehabilitation) (VA Form 28-1905m) Form	Modified

ICR Details

OMB Control No: 2900-0061	ICR Reference No: 202103-2900-019
Status: Received in OIRA	Previous ICR Reference No: 201403-2900-023
Agency/Subagency: VA	Agency Tracking No: VBA-VR&E-MS
Title: Request for Supplies (Chapter 31 - Vocational Rehabilitation) (VA Form 28-1905m)
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/23/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	28,000	0
Time Burden (Hours)	14,000	0
Cost Burden (Dollars)	0	0

---

Abstract: A claimant uses VAF 28-1905m to request supplies or equipment be provided as part of a rehabilitation program under 38 U.S.C. Chapter 31. The training facility the claimant attends, or the employer for whom the claimant works, may also need to complete the form when the facility or employer requires specific types of supplies or equipment under 38 U.S.C. 3104(a)(7). The VR&E program subsequently uses the information on this form to approve the purchase of appropriate supplies and equipment for claimants. Without the information gathered on this form, it is likely that inappropriate supplies or equipment may be provided which would negatively impact both the VA and the claimant.

---

Authorizing Statute(s): US Code: 38 USC 3104(a)(7) Name of Law: Scope of services and assistance
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 18376	04/08/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 32329	06/17/2021
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Request for Supplies (Chapter 31 - Vocational Rehabilitation) (VA Form 28-1905m)	28-1905m	Request and Authorization for Supplies (Chapter 31 - Veteran Readiness and Employement)

---

ICR Summary of Burden

	Total Request	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	28,000	0	0	12,000	0	16,000
Annual Time Burden (Hours)	14,000	0	0	-2,000	0	16,000
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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The VR&E program experienced an increase in rehabilitation plans developed since the last submission and VAF 28-1905m is used during the rehabilitation planning process. This increase in plans results in an increase in the use of VAF 28-1905m. The individual respondent burden decreased from one hour to 30 minutes. This decrease is associated with VAF 28-1905m only being used for the initial request of the supplies/equipment as opposed to also being used for receipt confirmation upon the supplies/equipment being delivered. A new form, VAF 28-1905r, is being developed for the purpose of verifying that the supplies/equipment have been received. Additionally, the items on VAF 28-1905m were reviewed and it was determined that the average claimant could complete the items in 30 minutes or less.

---

Annual Cost to Federal Government: $1,492,986

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

---

Common Form ICR:  No

---

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: 06/23/2021

---