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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
2900-0376
ICR Reference No:
201609-2900-003
Status:
Historical Active
Previous ICR Reference No:
201211-2900-003
Agency/Subagency:
VA
Agency Tracking No:
2900-0376
Title:
Agent Orange Registry Code Sheet
Type of Information Collection:
Reinstatement without change of a previously approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
08/25/2017
Retrieve Notice of Action (NOA)
Date Received in OIRA:
12/30/2016
Terms of Clearance:
OMB approves this collection consistent with the understanding that the VA Agent Orange Registry is created for administrative purposes. If any of the collected data is ultimately used for non-administrative purposes, such as for research, then VA will comply with the necessary Federal requirements to conduct such activities using data collected via the registry (e.g., IRB review, Privacy Act and confidentiality expectations, Information Quality Guidelines, PRA submission and review). VA will provide the "privacy policy for Agent Orange registry examinations" associated with this package to all patients participating int he registry.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
08/31/2020
36 Months From Approved
Responses
20,000
0
0
Time Burden (Hours)
6,667
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
This records symptoms, reproductive health problems and diagnoses detected during the Agent Orange Registry examination process and identifies veterans interested in knowing of health risks, research findings and new compensation policies through newsletters.
Authorizing Statute(s):
PL:
Pub.L. 100 - 687 Entirety
Name of Law: Veterans' Judicial Review Act of 1988
PL:
Pub.L. 102 - 585 703
Name of Law: Veterans Health Care Act of 1992
US Code:
38 USC Section 527
Name of Law: Evaluation and data collection
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
81 FR 69571
10/06/2016
30-day Notice:
Federal Register Citation:
Citation Date:
81 FR 94484
12/23/2016
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Agent Orange Registry Code Sheet
VA Form 10-9009
Agent Orange Registry Code Sheet
ICR Summary 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
20,000
0
0
0
0
20,000
Annual Time Burden (Hours)
6,667
0
0
0
0
6,667
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
No
Burden Increase Due to:
Burden decreases because of Program Change due to Agency Discretion:
No
Burden Reduction Due to:
Short Statement:
Annual Cost to Federal Government:
$1,677,220
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?
Uncollected
Agency Contact:
Cynthia Harvey - Pryor 202 461-5870 cynthia.harvey-pryor@va.gov
Common Form ICR:
No
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:
12/30/2016
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