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OMB Control No: 2900-0823	ICR Reference No: 202005-2900-019
Status: Historical Inactive	Previous ICR Reference No: 202005-2900-018
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: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 07/30/2020
	Date Received in OIRA: 07/15/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2020	36 Months From Approved	10/31/2020
Responses	22,758,371	0	22,758,371
Time Burden (Hours)	3,007,560	0	3,007,560
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; VA Form 10-10143e, Secondary Authorization Request for VA Community Care; VA Form 10-10143f, Community Care Document Cover Sheet; and VA Form 10-10143g, Non-VA Hospital Emergency Notification. Recently, in April and May 2020, OMB approved emergency PRA clearances for the two new forms added to this collection -- 10-10143f and 10-10143g -- due to their relevance to the COVID-19 national health emergency response. This submission is for a renewal of the PRA clearance for the entire collection under 2900-0823, which is necessary to provide continuous health care to Veterans under the VA Community Care 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:
	Not associated with rulemaking

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 35184	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

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:

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? Yes

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

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