Telehealth Grant Program (THGP) - AS20

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10-398a Corrective Action Plan (CAP) - THGP	Form and Instruction	New	Repair queued
Form 10-398 Program and Budget Changes - THGP	Form	New	Repair queued
Form 10-397c Quarterly Financial Report - THGP	Form and Instruction	New	Repair queued
Form 10-397b Annual Financial Report - THGP	Form and Instruction	New	Repair queued
Form 10-397a Other Grantee Performance Report - THGP	Form	New	Repair queued
Form 10-397 Annual Grantee Performance Report - THGP	Form	New	Repair queued
Form 10-396a Grantee Satisfaction Survey - THGP	Form	New	Repair queued
Form 10-396 Veteran Satisfaction Survey - THGP	Form	New	Repair queued
Form 10-395a Renewal Application - THGP	Form and Instruction	New	Repair queued
Form 10-395 Application - THGP	Form and Instruction	New	Repair queued
Supporting Statement A_2900-NEW_Telehealth Grant Program (THGP)_AS20_updated 11132024.docx	Supporting Statement A	Uploaded 2024-11-13	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
271219	Corrective Action Plan (CAP) - THGP	Form and Instruction	New
271218	Program and Budget Changes - THGP	Form	New
271217	Quarterly Financial Report - THGP	Form and Instruction	New
271216	Annual Financial Report - THGP	Form and Instruction	New
271214	Other Grantee Performance Report - THGP	Form	New
271213	Annual Grantee Performance Report - THGP	Form	New
271211	Grantee Satisfaction Survey - THGP	Form	New
271209	Veteran Satisfaction Survey - THGP	Form	New
271206	Renewal Application - THGP	Form and Instruction	New
271205	Application - THGP	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202409-2900-010
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No: VHA-2900-NEW
Title: Telehealth Grant Program (THGP) - AS20
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: 11/13/2024

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	1,090	0
Time Burden (Hours)	2,418	0
Cost Burden (Dollars)	0	0

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Abstract: On October 17, 2020, the Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019, Public Law (P. L.) 116-171 (the Act), codified as a note to section 1720F of title 38, United States Code (U.S.C.), was enacted into law. Section 701 of the Act mandated that VA establish the Telehealth Grant Program for the expansion of telehealth capabilities and the provision of telehealth services to Veterans. To award grants under this program, and assess compliance with grants provided, VA will require submission of Applications for grants and Renewals of grants, Grantee and Veteran Surveys, and Compliance Reports.

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Authorizing Statute(s): PL: Pub.L. 116 - 171 701 Name of Law: Commander John Scott Hannon Veterans Mental Health Care Improvement Act of 2019
   US Code: 38 USC 1720F Name of Law: Comprehensive program for suicide prevention among veterans
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AS20	Proposed rulemaking	89 FR 89519	11/13/2024

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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: 10

table that charts list of burden

IC Title	Form No.	Form Name
Annual Financial Report - THGP	10-397b	Annual Financial Report
Annual Grantee Performance Report - THGP	10-397	Annual Grantee Performance Report
Application - THGP	10-395	Application
Corrective Action Plan (CAP) - THGP	10-398a	Corrective Action Plan (CAP)
Grantee Satisfaction Survey - THGP	10-396a	Grantee Satisfaction Survey Form
Other Grantee Performance Report - THGP	10-397a	Other Grantee Performance Report
Program and Budget Changes - THGP	10-398	Program and Budget Changes
Quarterly Financial Report - THGP	10-397c	Quarterly Financial Report
Renewal Application - THGP	10-395a	Renewal Application
Veteran Satisfaction Survey - THGP	10-396	Veteran Satisfaction Survey

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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	1,090	0	0	1,090	0	0
Annual Time Burden (Hours)	2,418	0	0	2,418	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 a new collection, and all burden hours are considered a program increase.

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Annual Cost to Federal Government: $50,400

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: 11/13/2024

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