Applications & Appraisals for Title 38 Health Care Positions and Trainees

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10-2850e Appraisal of Applicant	Form and Instruction	New	Available
Form 10-2850e Appraisal of Applicant - VA Form 10-2850e	Form and Instruction	New	Repair queued
Form 10-2850c Application for Associated Health Occupations	Form and Instruction	New	Available
Form 10-2850c Application for Associated Health Occupations - VA Form 10-2850c	Form and Instruction	New	Available
Form 10-2850a Application for Nurses and Nurse Anesthetists - VA Form 10-2850a	Form and Instruction	New	Available
Form 10-2850a Application for Nurses and Nurse Anesthetists - VA Form 10-2850a	Form and Instruction	New	Repair queued
Form 10-2850 Application for Physicians, Dentists, Podiatrists, Optometrists and Chiropractors - VA Form 10-2850	Form and Instruction	New	Repair queued
Form 10-2850 Application for Physicians, Dentists, Podiatrists, Optometrists and Chiropractors - VA Form 10-2850	Form and Instruction	New	Repair queued
Form 10-2850d Health Professions Trainee Data Collection Form - VA Form 10-2850d	Form and Instruction	Modified	Available
Form 10-2850d Health Professions Trainee Data Collection Form - VA Form 2850d	Form and Instruction	Modified	Repair queued
30-Day FRN_2900-0205_Applications and Appraisals for Titles 38 Health Care Positions and Trainees_published 04072023.pdf	Supplementary Document	Uploaded 2023-04-10	Repair queued
60-Day FRN_2900-0205_Applications and Appraisals for Titles 38 Health Care Positions and Trainees_published 01202023.pdf	Supplementary Document	Uploaded 2023-02-24	Repair queued
Supporting Statement A_2900-0205_Applications & Appraisals for Title 38 Health Care Positions & Trainees_updated Apr 2023.docx	Supporting Statement A	Uploaded 2023-04-10	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
257919	Appraisal of Applicant - VA Form 10-2850e	Form and Instruction	New	Appraisal of Applicant
257919	Appraisal of Applicant - VA Form 10-2850e	Form and Instruction	New
257918	Application for Associated Health Occupations - VA Form 10-2850c	Form and Instruction	New	Application for Associated Health Occupations
257918	Application for Associated Health Occupations - VA Form 10-2850c	Form and Instruction	New
257917	Application for Nurses and Nurse Anesthetists - VA Form 10-2850a	Form and Instruction	New	Application for Nurses and Nurse Anesthetists - VA Form 10-2850a
257917	Application for Nurses and Nurse Anesthetists - VA Form 10-2850a	Form and Instruction	New
257916	Application for Physicians, Dentists, Podiatrists, Optometrists and Chiropractors - VA Form 10-2850	Form and Instruction	New	Application for Physicians, Dentists, Podiatrists, Optometrists and Chiropractors - VA Form 10-2850
257916	Application for Physicians, Dentists, Podiatrists, Optometrists and Chiropractors - VA Form 10-2850	Form and Instruction	New
235698	Health Professions Trainee Data Collection Form - VA Form 2850d	Form and Instruction	Modified	Health Professions Trainee Data Collection Form - VA Form 10-2850d
235698	Health Professions Trainee Data Collection Form - VA Form 2850d	Form and Instruction	Modified

ICR Details

OMB Control No: 2900-0205	ICR Reference No: 202301-2900-008
Status: Historical Active	Previous ICR Reference No: 201904-2900-002
Agency/Subagency: VA	Agency Tracking No: 2900-0205
Title: Applications & Appraisals for Title 38 Health Care Positions and Trainees
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/16/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 04/10/2023
Terms of Clearance: OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action. The agency will also remove the common form designation in the next request for approval.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2026	36 Months From Approved	05/31/2023
Responses	273,963	0	121,000
Time Burden (Hours)	136,982	0	60,500
Cost Burden (Dollars)	0	0	0

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Abstract: The collection of this information is authorized by Title 38, United States Code (U.S.C.) 7403, (Veterans’ Benefits), which provides that appointments of Title 38 employees will be made only after qualifications have been satisfactorily verified in accordance with regulations prescribed by the Secretary. Occupations listed in 38 U.S.C. 7401(1) and 7401(3) (Appointments in Veterans Health Administration), are appointed at a grade and step rate or an assignment based on careful evaluation of their education and experience. VA Forms 10-2850, 10-2850a and 10-2850c are applications designed specifically to elicit appropriate information about each candidate's qualifications for employment with Department of Veterans Affairs (VA) as well as educational and experience. To assure that a full evaluation of each candidate's credentials can be made prior to employment, the forms require disclosure of details about all licenses ever held, Drug Enforcement Administration certification, board certification, clinical privileges, revoked certification or registration, liability insurance history, and involvement in malpractice proceedings. VA Form 10-2850d is used to collect appropriate information about qualifications for each trainee participating in accredited educational programs with VA. VA Form 10-2850e is the pre-employment reference form used to elicit information concerning the prior education and/or performance of the Title 38 applicant. Information provided is used to determine eligibility for employment and the appropriate grade and step rate or assignment.

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Authorizing Statute(s): US Code: 38 USC 7401 (1),(3) Name of Law: Appointments in Veterans Health Administration
   US Code: 38 USC 7403 Name of Law: Veterans Benefits - Period of appointments; promotions
   US Code: 38 USC 7302 - Part V, Chapter 73 Name of Law: Healthcare Personnel Education and Training Program
  

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:
	88 FR 3781	01/20/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 20946	04/07/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Application for Associated Health Occupations - VA Form 10-2850c	10-2850c	Application for Associated Health Occupations
Application for Nurses and Nurse Anesthetists - VA Form 10-2850a	10-2850a	Application for Nurses and Nurse Anesthetists - VA Form 10-2850a
Application for Physicians, Dentists, Podiatrists, Optometrists and Chiropractors - VA Form 10-2850	10-2850	Application for Physicians, Dentists, Podiatrists, Optometrists and Chiropractors - VA Form 10-2850
Appraisal of Applicant - VA Form 10-2850e	10-2850e	Appraisal of Applicant
Health Professions Trainee Data Collection Form - VA Form 2850d	10-2850d	Health Professions Trainee Data Collection Form - VA Form 10-2850d

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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	273,963	121,000	0	152,963	0	0
Annual Time Burden (Hours)	136,982	60,500	0	76,482	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: Burden increase is due to inclusion for VA Form 10-2850d with other forms in this collection.

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Annual Cost to Federal Government: $15,172,527

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: 04/10/2023

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