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:
2900-0556
ICR Reference No:
202005-2900-003
Status:
Historical Active
Previous ICR Reference No:
201704-2900-012
Agency/Subagency:
VA
Agency Tracking No:
2900-0556
Title:
VA Advance Directive - Durable Power of Attorney for Health Care and Living Will
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Emergency
Approval Requested By:
05/08/2020
OIRA Conclusion Action:
Approved without change
Conclusion Date:
06/02/2020
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/07/2020
Terms of Clearance:
Emergency approval is granted. VA shall proceed with the normal clearance process in order to avoid a lapse in OMB approval. VA shall accept the close personal friend statement approved under this control number in any reasonable manner. If VA wishes to require a specific format or method of submission, VA shall submit for OMB review.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2020
6 Months From Approved
12/31/2020
Responses
300
0
343,622
Time Burden (Hours)
50
0
171,811
Cost Burden (Dollars)
0
0
0
Abstract:
Section 7331 of title 38, United States Code (U.S.C.), requires, in relevant part, that the Secretary of Veterans Affairs, upon the recommendation of the Under Secretary for Health, prescribe regulations to ensure, to the maximum extent practicable, that all VA patient care be carried out only with the full and informed consent of the patient, or in appropriate cases, a representative thereof. Based on VA’s interpretation of this statute and our mandate in 38 U.S.C. 7301(b) to provide a complete medical and hospital service, we recognize that patients with decision-making capacity have the right to state their treatment preferences in a VA or other valid advance directive. The VA advance directive form (both English and Spanish language versions) is VA Form 10-0137. These forms have a current OMB Paperwork Reduction Act (PRA) clearance under OMB Control Number 2900-0556. When a Veteran is incapacitated and does not have an advance directive, the VA regulations allow a statement to be submitted from a “Close Personal Friend” who will be responsible for making health care decisions on behalf of the Veteran. This request for an emergency PRA clearance applies to the addition of the collection of a “Close Personal Friend Statement” to 2900-0556.
Emergency Justfication:
This request for an emergency PRA clearance applies to the addition of the collection of a “Close Personal Friend Statement” to 2900-0556. It is estimated that 300 statements will be collected annually, with a burden of 10 minutes per statement. This information collection is noticed in the interim final rule associated with RIN 2900-AQ97. Emergency clearance is requested because AQ97 changed from a proposed rule to an interim final rule that will soon be cleared for publication in the Federal Register. The use of regular OMB clearance procedures will not allow for coordination of the PRA clearance with publication of the rule.
Authorizing Statute(s):
US Code:
38 USC 7331
Name of Law: Informed consent
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
2900-AQ97
Final or interim final rulemaking
85 FR 31690
05/27/2020
Federal Register Notices & Comments
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
Close Personal Friend Statement of Relationship to Veteran
Durable Power of Attorney for Health Care and Living Will, VA Advance Directive
10-0137, 10-0137
VA Advance Directive - Durable Power of Attorney for Health Care and Living Will
,
VA Advance Directive - Durable Power of Attorney for Health Care and Living Will - Spanish_English
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
300
343,622
0
-343,322
0
0
Annual Time Burden (Hours)
50
171,811
0
-171,761
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:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
VA Forms 10-0137, English and Spanish language versions, are currently approved for a PRA clearance until 12/31/2020. Therefore, the burden for these forms has been removed from this emergency clearance request. VA is requesting this emergency PRA clearance for the addition of the collection of a Close Personal Friend Statement from approximately 300 persons per year, pursuant to interim final rule with RIN 2900-AQ97. Only the burden for this additional information collection is included in this request for emergency PRA clearance.
Annual Cost to Federal Government:
$0
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
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:
05/07/2020
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