Receipt of Supplies (Chapter 31 - Veteran Readiness and Employment) (VA Form 28-1905r)

Forms and Documents

Document Name	Status
Form VA Form 28-1905r VAF 28-1905r, Receipt of Supplies (Chapter 31 - Veteran Readiness and Employment) Form	New
2021-17324.pdf Supplementary Document	2021-11-01
60-DAY FRN.pdf Supplementary Document	2021-08-09
28-1905r supporting statement .docx Supporting Statement A	2021-08-09

IC Document Collections

IC ID	Document Title	Status
246509	VAF 28-1905r, Receipt of Supplies (Chapter 31 - Veteran Readiness and Employment) Form	New

ICR Details

OMB Control No:	ICR Reference No: 202103-2900-028
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No: VBA-VR&E-NK
Title: Receipt of Supplies (Chapter 31 - Veteran Readiness and Employment) (VA Form 28-1905r)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  Yes
Type of Review Request: Regular	Date Submitted to OIRA: 11/01/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	28,000	0
Time Burden (Hours)	4,667	0
Cost Burden (Dollars)	0	0

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Abstract: A claimant will use VA Form 28-1905r, Receipt of Supplies (Chapter 31 – Veteran Readiness and Employment), to verify that the supplies and/or equipment provided as part of a rehabilitation program under 38 U.S.C. Chapter 31 have been received and are in good condition. The VR&E program subsequently uses the information on this form to justify processing payments for the supplies and/or equipment provided to claimants under 38 U.S.C. 3104(a)(7). Without the information gathered on this form, the VR&E program would be unable to verify that the claimant received the supplies and/or equipment, which could result in inaccurate payments being rendered.

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

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 26257	05/13/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 17295	08/13/2021
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
VAF 28-1905r, Receipt of Supplies (Chapter 31 - Veteran Readiness and Employment)	VA Form 28-1905r	Receipt of Supplies (Chapter 31 - Veteran Readiness and Employment)

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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	28,000	0	0
Annual Time Burden (Hours)	4,667	0	0	4,667	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: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a new collection.

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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

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Common Form ICR:  Yes

Description/Changes for Common Form Usage: 

Approved RCFs using this ICR

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: 11/01/2021

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