EMPLOYMENT CERTIFICATION FORM (VA Form 22-10201)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form VA Form 22-10201 Employment Certification Form	Form	Modified	Repair queued
Non Material Non Substatial Revision Request for Revision of VET TEC EMPLOYMENT CERTIFICATION FORM (002) 05052021.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2021-05-05	Available
Participation Agreement Payment Clause.pdf	Supplementary Document	Uploaded 2019-12-18	Repair queued
30-Day FRN - 2900-New (VA Form 22-10201) 2019.pdf	Supplementary Document	Uploaded 2019-06-11	Repair queued
VET TEC Employment Verification Form SupportingStatement.docx	Supporting Statement A	Uploaded 2019-06-12	Repair queued
60-Day FRN - 2900-NEW (VA Form 22-10201) 2019.pdf	Supplementary Document	Uploaded 2019-04-18	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
235408	Employment Certification Form	Form	Modified

ICR Details

OMB Control No: 2900-0874	ICR Reference No: 202105-2900-002
Status: Received in OIRA	Previous ICR Reference No: 201903-2900-023
Agency/Subagency: VA	Agency Tracking No: VBA-EDU-NK
Title: EMPLOYMENT CERTIFICATION FORM (VA Form 22-10201)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/06/2021

table that charts list comparision

	Requested	Previously Approved
Expiration Date	12/31/2022	12/31/2022
Responses	562,500	562,500
Time Burden (Hours)	46,875	46,875
Cost Burden (Dollars)	0	0

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Abstract: On August 16, 2017, the President signed into law the Harry W. Colmery Veterans Educational Assistance Act of 2017(“Forever GI Bill”), Public Law 115-48, which amends Title 38, United States Code to make certain improvements in the laws administered by the Secretary of Veterans Affairs (VA), and for other purposes. Section 116 of the law authorizes VA to establish a 5-year high technology pilot program for veterans as an educational program provided by leading technology employers. Section 116 also requires that VA receive employment certification from school certifying officials (SCOs) and veterans enrolled in the VET TEC pilot program.

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Authorizing Statute(s): PL: Pub.L. 115 - 48 116 Name of Law: Harry W. Colmery Veterans Educational Assistance Act of 2017
  

Citations for New Statutory Requirements: PL: Pub.L. 115 - 48 116 Name of Law: Harry W. Colmery Veterans Educational Assistance Act of 2017

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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:
	84 FR 12670	04/02/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 26938	06/10/2019
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
Employment Certification Form	VA Form 22-10201	Employment Certification Form

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ICR Summary of Burden

table that charts list 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	562,500	562,500	0	0	0	0
Annual Time Burden (Hours)	46,875	46,875	0	0	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:

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Annual Cost to Federal Government: $3,422,813

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: 05/06/2021

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