VHA Fraud, Waste and Abuse Complaints (VA Form 10-390)

Forms and Documents

Document Name	Status
Form 10-390 VHA Fraud, Waste and Abuse Complaint Form Form and Instruction	New
30-Day FRN_2900-NEW_VHA Fraud, Waste and Abuse Complaint Form_VA Form 10-390_published 08282024.pdf Supplementary Document	2024-08-28
60-Day FRN_2900-NEW_VHA Fraud, Waste and Abuse Complaint Form_VA Form 10-390_published 06202024.pdf Supplementary Document	2024-06-20
Supporting Statement A_2900-NEW_OIC Fraud Waste and Abuse Complaints_VA Form 10-390_updated 08292024.docx Supporting Statement A	2024-08-29

IC Document Collections

IC ID	Document Title	Status
268547	Mail, Email, Hotline and Fax Complaints	New
268544	VHA Fraud, Waste and Abuse Complaint Form Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202405-2900-006
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No: VHA-2900-NEW
Title: VHA Fraud, Waste and Abuse Complaints (VA Form 10-390)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/29/2024

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	1,700	0
Time Burden (Hours)	283	0
Cost Burden (Dollars)	0	0

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Abstract: The Secretary has broad authority under Title 38 United States Code, section 501, to protect Veterans and their family members from fraud and enforce compliance with federal laws and regulations. The Department is an active participant in the cross-government Veteran Scam and Fraud Evasion (VSAFE) campaign and Task Force, and this information collection supports the goal of “no wrong door” for the reporting and resolution of potential fraudulent issues. An individual can file a complaint or comment with the office by sending a letter using regular mail, telephoning, emailing, or, in the future, by filing a web-based complaint. Information is gathered only from the individual submissions and may be submitted anonymously. The new VA Form 10-390 can be used by individuals to capture information for a fraud, waste or abuse complaint. The form may be submitted anonymously, and there is no requirement to complete all fields. Once received by Department staff, complaints are entered into the Compliance Inquiry Reporting & Tracking System (CIRTS), (System of Record Notice: 110VA17 “Compliance Record, Response, and Resolution of Reports of Persons Allegedly Involved in Compliance Violations—VA)” and assigned to appropriate Department offices. Complaints can be reassigned to appropriate program offices with VHA or routed to VBA. In appropriate instances, the office investigates the complaint and may refer to law enforcement.

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Authorizing Statute(s): US Code: 38 USC 501 Name of Law: Rules and Regulations
  

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:
	89 FR 51948	06/20/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 68984	08/28/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Mail, Email, Hotline and Fax Complaints
VHA Fraud, Waste and Abuse Complaint Form	10-390	VHA Fraud, Waste and Abuse Complaint Form

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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	1,700	0	0	1,700	0	0
Annual Time Burden (Hours)	283	0	0	283	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, and all burden hours are considered a program increase.

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Annual Cost to Federal Government: $27,486

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: 08/29/2024

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