State Home Programs for
Veterans (VA Forms 10-5588, 10-5588A, 10-10SH) -- AR61
Revision of a currently approved collection
No
Regular
10/30/2024
Requested
Previously Approved
10/31/2026
10/31/2026
13,616
13,614
4,819
4,816
0
0
The information collection under OMB
Control Number 2900-0160 includes VA Forms 10-5588, 10-5588A, and
10-10SH and has a current Paperwork Reduction Act (PRA) clearance
with an expiration date of 10/31/2026. VHA is implementing a new
regulation that will add another element to this information
collection. Specifically, the new regulation will allow State homes
to submit a list of veteran names to VA for reconsideration of
previously denied claims. This will be a time limited opportunity
that must occur within 30 days of the effective date of the rule.
Authority for this information collection can be found in two
public laws affecting State homes: Public Law 115-159, the State
Veterans Home Adult Day Health Care Improvement Act of 2017, which
requires VA to pay State Veteran Homes (SVHs) for medical model
adult day health care provided to certain eligible Veterans; and
Public Law 116-315, Section 3007, Waiver of Requirements of
Department of Veterans Affairs for Receipt of Per Diem Payments for
Domiciliary Care at State Homes and Modification of Eligibility for
such Payments. This information collection also enables the payment
of per diem to State homes that provide care to eligible Veterans
in accordance with Title 38, CFR Part 51. The intended effect of
these provisions is to create a safeguard that Veterans are
receiving a high quality of care in SVHs. To ensure that high
quality care is furnished to Veterans, VA requires those facilities
providing nursing home care, domiciliary care, and adult day health
care programs to Veterans to supply various kinds of information.
The information required includes an application and justification
for payment; records and reports that facility management must
maintain regarding payment activities of residents or participants;
and records and reports that facilities management and health care
professionals must maintain regarding eligibility and level of care
for residents or participants. The following three forms are
included in this information collection: 10-5588, 10-5588A, and
10-10SH. The State Home Per Diem (SHPD) Program made updates to the
automated the 10-10SH form to increase functionality and usage.
This form was converted into a web-based, fillable form that can be
electronically submitted from the SVH to the appropriate VAMC. It
includes data field validation, assuring that all required fields
have been filled before the user can electronically submit the
10-10SH form. The VA portion of the application also includes
business rules to assist the VA representatives in making uniform
determinations, allow the VA representative to return incomplete
applications to the SVH along with a notification to them, and
record the receipt of the completed application.
PL:
Pub.L. 115 - 159 2 Name of Law: State Veterans Home Adult Day
Health Care Improvement Act of 2017
PL:
Pub.L. 116 - 315 3007 Name of Law: Veterans Health Care and
Benefits Improvement Act of 2020
PL:
Pub.L. 109 - 461 211(a)(5) Name of Law: Veterans Benefits,
Health Care, and Information Technology - Modification to State
Home Authorities
The burden hour increase is due
to new authority granted by section 3007(a) of the Johnny Isakson
and David P. Roe, M.D. Veterans Health Care and Benefits
Improvement Act of 2020 (Pub. L. 116-315, January 5, 2021) which
allows VA to submit a List of Veteran Names for Claim
Reconsideration. 38 CFR 51.42(c) provides for the resubmission of
the names of Veterans whose claims were previously denied by VA,
and this will add an estimated 3 burden hours to the
collection.
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:
(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;
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.
Form 10-10SH State Homes Program Application for Veterans Care Medical Certification
SSA_2900-0160_State Home Programs for Veterans_AR61-F_updated Oct 2024.docx
List of Veteran Names for Reconsideration