VHA Readjustment Counseling Service Scholarship Program (RCSSP) - AR31

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10-264M Mobility Agreement	Form and Instruction	Unchanged	Available
Form 10-264K Scholarship Offer Response	Form and Instruction	Unchanged	Available
Form 10-264J Request for Deferment	Form and Instruction	Unchanged	Available
Form 10-264I Notice of Change and-or Academic Status	Form and Instruction	Unchanged	Available
Form 10-264H Notice of Approaching Graduation	Form and Instruction	Unchanged	Available
Form 10-264F Scholarship Agreement	Form and Instruction	Unchanged	Available
Form 19-264D Education Program Completion Notice	Form and Instruction	Unchanged	Available
Form 19-264D Readjustment Counseling Service Scholarship Program (RCSSP) - Selected Participants	Form and Instruction	Unchanged	Repair queued
Form 10-264G Application	Form and Instruction	Unchanged	Available
Form 10-264E Evaluation and Recommendation	Form and Instruction	Unchanged	Available
Form 10-264A Addendum to Application	Form and Instruction	Unchanged	Available
Form 10-264 Academic Verification	Form and Instruction	Unchanged	Available
Form 10-264 Readjustment Counseling Service Scholarship Program (RCSSP) - Applicants	Form and Instruction	Unchanged	Repair queued
Supporting Statement A_RCS Scholarship Program (RCSSP)_AR31_2900-0899_updated Nov 2022.docx	Supporting Statement A	Uploaded 2022-12-08	Available
Supporting Statement A_RCS Scholarship Program (RCSSP)_AR31_2900-0899_updated Nov 2022.docx	Supporting Statement A	Uploaded 2022-12-08	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
250256	Readjustment Counseling Service Scholarship Program (RCSSP) - Selected Participants	Form and Instruction	Unchanged	Mobility Agreement
250256	Readjustment Counseling Service Scholarship Program (RCSSP) - Selected Participants	Form and Instruction	Unchanged	Scholarship Offer Response
250256	Readjustment Counseling Service Scholarship Program (RCSSP) - Selected Participants	Form and Instruction	Unchanged	Request for Deferment
250256	Readjustment Counseling Service Scholarship Program (RCSSP) - Selected Participants	Form and Instruction	Unchanged	Notice of Change and-or Academic Status
250256	Readjustment Counseling Service Scholarship Program (RCSSP) - Selected Participants	Form and Instruction	Unchanged	Notice of Approaching Graduation
250256	Readjustment Counseling Service Scholarship Program (RCSSP) - Selected Participants	Form and Instruction	Unchanged	Scholarship Agreement
250256	Readjustment Counseling Service Scholarship Program (RCSSP) - Selected Participants	Form and Instruction	Unchanged	Education Program Completion Notice
250256	Readjustment Counseling Service Scholarship Program (RCSSP) - Selected Participants	Form and Instruction	Unchanged
250254	Readjustment Counseling Service Scholarship Program (RCSSP) - Applicants	Form and Instruction	Unchanged	Application
250254	Readjustment Counseling Service Scholarship Program (RCSSP) - Applicants	Form and Instruction	Unchanged	Evaluation and Recommendation
250254	Readjustment Counseling Service Scholarship Program (RCSSP) - Applicants	Form and Instruction	Unchanged	Addendum to Application
250254	Readjustment Counseling Service Scholarship Program (RCSSP) - Applicants	Form and Instruction	Unchanged	Academic Verification
250254	Readjustment Counseling Service Scholarship Program (RCSSP) - Applicants	Form and Instruction	Unchanged

ICR Details

OMB Control No: 2900-0899	ICR Reference No: 202211-2900-010
Status: Historical Active	Previous ICR Reference No: 202107-2900-003
Agency/Subagency: VA	Agency Tracking No: 2900-0899
Title: VHA Readjustment Counseling Service Scholarship Program (RCSSP) - AR31
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/16/2022
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/08/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2025	36 Months From Approved
Responses	55	0	0
Time Burden (Hours)	158	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This information collection is necessary due to the mandates of section 502 of Public Law 115-171, the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019, which amended Chapter 76 of title 38 United States Code (U.S.C.) by establishing new sections 7698 through 7699B and creating a new scholarship program known as the Readjustment Counseling Service Scholarship Program (RCSSP). This legislation authorizes the Department of Veterans Affairs (VA) Readjustment Counseling Service (RCS) to provide scholarship awards to individual Veterans enrolled in accredited academic programs leading to an appointment in one of the selected health professional occupations (psychology, social work, marriage and family therapy, or mental health counseling). The RCSSP would serve as an incentive to eligible individuals to further their own career development through completing a graduate degree in one of these four professions. Implementation of the RCSSP would also provide increased access to care for eligible individuals by filling existing vacancies in Vet Centers located in sparsely populated areas distant from other Vet Centers. It is expected that many of these scholarship recipients will continue with VA employment after completion of their service obligation. Legal authority for this data collection is found under 38 USC, Part I, Chapter 5, Section 527 that authorizes the collection of data that will allow measurement and evaluation of the Department of Veterans Affairs Programs, the goal of which is improved health care for veterans.

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Authorizing Statute(s): PL: Pub.L. 115 - 171 502 Name of Law: Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019
  

Citations for New Statutory Requirements: PL: Pub.L. 115 - 171 502 Name of Law: CMDR John Scott Hannon Veterans Mental Health Care Improvement Act of 2019

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AR31	Final or interim final rulemaking	87 FR 71254	11/22/2022

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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

table that charts list of burden

IC Title	Form No.	Form Name
Readjustment Counseling Service Scholarship Program (RCSSP) - Applicants	10-264, 10-264E, 10-264G, 10-264A	Academic Verification ,   Addendum to Application ,   Evaluation and Recommendation ,   Application
Readjustment Counseling Service Scholarship Program (RCSSP) - Selected Participants	10-264F, 19-264D, 10-264H, 10-264I, 10-264J, 10-264K, 10-264M	Education Program Completion Notice ,   Scholarship Agreement ,   Notice of Approaching Graduation ,   Notice of Change and-or Academic Status ,   Request for Deferment ,   Scholarship Offer Response ,   Mobility Agreement

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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	55	0	0	55	0	0
Annual Time Burden (Hours)	158	0	0	158	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: This is a new collection, and all burden hours are an increase.

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Annual Cost to Federal Government: $960

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:  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: 12/08/2022

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