View Information Collection Request (ICR) Package

OMB Control No: 2900-0205	ICR Reference No: 202301-2900-008
Status: Active	Previous ICR Reference No: 201904-2900-002
Agency/Subagency: VA	Agency Tracking No: 2900-0205
Title: Applications & Appraisals for Title 38 Health Care Positions and Trainees
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: Yes
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/16/2023
	Date Received in OIRA: 04/10/2023
Terms of Clearance: OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action. The agency will also remove the common form designation in the next request for approval.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2026	36 Months From Approved	05/31/2023
Responses	273,963	0	121,000
Time Burden (Hours)	136,982	0	60,500
Cost Burden (Dollars)	0	0	0

Abstract: The collection of this information is authorized by Title 38, United States Code (U.S.C.) 7403, (Veterans’ Benefits), which provides that appointments of Title 38 employees will be made only after qualifications have been satisfactorily verified in accordance with regulations prescribed by the Secretary. Occupations listed in 38 U.S.C. 7401(1) and 7401(3) (Appointments in Veterans Health Administration), are appointed at a grade and step rate or an assignment based on careful evaluation of their education and experience. VA Forms 10-2850, 10-2850a and 10-2850c are applications designed specifically to elicit appropriate information about each candidate's qualifications for employment with Department of Veterans Affairs (VA) as well as educational and experience. To assure that a full evaluation of each candidate's credentials can be made prior to employment, the forms require disclosure of details about all licenses ever held, Drug Enforcement Administration certification, board certification, clinical privileges, revoked certification or registration, liability insurance history, and involvement in malpractice proceedings. VA Form 10-2850d is used to collect appropriate information about qualifications for each trainee participating in accredited educational programs with VA. VA Form 10-2850e is the pre-employment reference form used to elicit information concerning the prior education and/or performance of the Title 38 applicant. Information provided is used to determine eligibility for employment and the appropriate grade and step rate or assignment.

Authorizing Statute(s): US Code: 38 USC 7401 (1),(3) Name of Law: Appointments in Veterans Health Administration
   US Code: 38 USC 7403 Name of Law: Veterans Benefits - Period of appointments; promotions
   US Code: 38 USC 7302 - Part V, Chapter 73 Name of Law: Healthcare Personnel Education and Training Program

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:
	88 FR 3781	01/20/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 20946	04/07/2023
Did the Agency receive public comments on this ICR? No

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	273,963	121,000	152,963
Annual Time Burden (Hours)	136,982	60,500	76,482
Annual Cost Burden (Dollars)	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: Burden increase is due to inclusion for VA Form 10-2850d with other forms in this collection.

Annual Cost to Federal Government: $15,172,527

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: Yes
Description/Changes for Common Form Usage:

Approved RCFs using this ICR

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

View ICR - OIRA Conclusion