View Information Collection Request (ICR) Package

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: 2900-0205	ICR Reference No: 201904-2900-002
Status: Historical Active	Previous ICR Reference No: 201502-2900-007
Agency/Subagency: VA	Agency Tracking No: 2900-0205
Title: Application for Health Professions Trainees - VA Form 10-2850D
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/10/2019
	Date Received in OIRA: 08/13/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2022	36 Months From Approved	09/30/2018
Responses	121,000	0	386,726
Time Burden (Hours)	60,500	0	139,016
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion	Change Due to Adjustment in Estimate
Annual Number of Responses	121,000	386,726	121,000	-386,726
Annual Time Burden (Hours)	60,500	139,016	60,500	-139,016
Annual Cost Burden (Dollars)	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: VA Form 10-2850D is an application specific to health professions trainees appointed under Title 38. There is no other source specific to health professions trainees that are accessible to VA management and personnel officials charged with making appointment determinations. The VA Form 10-2850D will assist VA to be compliant with key screening requirements for trainees with less of a burden on trainees and VA officials responsible for the screening process. Only trainees that meet established qualifications and security requirements based on the information in form 10-2850D will be appointed to VA.

Annual Cost to Federal Government: $1,968,650

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: Frances O'Donnell 703 405-2449 fran.odonnell@cathexiscorp.com

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.