View Information Collection Request (ICR) Package
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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:
2900-0823
ICR Reference No:
201905-2900-007
Status:
Historical Active
Previous ICR Reference No:
201604-2900-018
Agency/Subagency:
VA
Agency Tracking No:
2900-0823
Title:
Expanded Access to Non-VA Care Through the Mission Act: Veterans Community Care Program (VCCP)
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
04/01/2020
Retrieve Notice of Action (NOA)
Date Received in OIRA:
03/31/2020
Terms of Clearance:
This revision is approval pursuant to 5 CFR 1320.13.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
06/30/2020
36 Months From Approved
06/30/2020
Responses
22,258,371
0
12,729,667
Time Burden (Hours)
2,924,227
0
1,786,557
Cost Burden (Dollars)
0
0
0
Abstract:
Section 101 of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 requires VA to implement the Veterans Community Care Program (VCCP) to furnish care in the community to covered Veterans through eligible entities and providers, under circumstances as further prescribed in the MISSION Act. VA currently collects information that will be required to implement the Veterans Community Care Program under the Veterans Choice Program, through an OMB approved collection 2900-0823. OMB collection 2900-0823 includes VA Form 10-10143, Election to Receive Authorized Non-VA Care and Selection of Provider for the Veterans Choice Program; VA Form 10-10143a, Health-Care Plan Information for the Veterans Choice Program; VA Form 10-10143b, Submission of Medical Record Information under the Veterans Choice Program; VA Form 10-10143c, Submission of Information on Credentials and Licenses by Eligible Entities and Providers; and VA Form 10-10143e, Secondary Authorization Request for VA Community Care. A new form also will be added to this collection: VA Form 10-10143f, Community Care Document Cover Sheet. VA seeks to update OMB collection 2900-0823 to implement the Veterans Community Care Program by updating the title of VA forms and any associated statutory citations to be consistent with the new program and the MISSION Act, and by updating burden hours to account for estimated increased use of community care under the new program.
Authorizing Statute(s):
PL:
Pub.L. 115 - 182 101
Name of Law: VA MISSION Act of 2018
Citations for New Statutory Requirements:
PL: Pub.L. 115 - 182 101 Name of Law: VA MISSION Act of 2018
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
2900-AQ46
Final or interim final rulemaking
84 FR 21668
05/14/2019
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
84 FR 35181
07/22/2019
30-day Notice:
Federal Register Citation:
Citation Date:
84 FR 53570
10/07/2019
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
6
IC Title
Form No.
Form Name
10-10143 Election to Receive Authorized Non-VA Care and Selection of Provider for the Veterans Community Care Program
10-10143a Health-Care Plan Information for the Veterans Choice Program
10-10143a
Health Care Plan Information for the Veterans Choice Program
10-10143b Submission of Medical Record Information under the Veterans Community Care Program
10-10143c Submission of Information on Credentials and Licenses by Eligible Entities and Providers
10-10143e Secondary Authorization Request (SAR) for VA Community Care
10-10143e
SAR for VA Community Care
10-10143f - Community Care Document Cover Sheet
10-10143f
Community Care Document Cover 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
22,258,371
12,729,667
9,028,704
500,000
0
0
Annual Time Burden (Hours)
2,924,227
1,786,557
1,096,003
41,667
0
0
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:
Section 101 of the MISSION Act establishes different and broader eligibility to receive care in the community than the current Veterans Choice Program. This accounts for the estimated increase in covered Veterans who will use community care under the VCCP.
Annual Cost to Federal Government:
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
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:
03/31/2020
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