View Information Collection Request (ICR) Package

OMB Control No: 2900-0883	ICR Reference No: 202306-2900-012
Status: Active	Previous ICR Reference No: 202005-2900-011
Agency/Subagency: VA	Agency Tracking No: 2900-0883
Title: Per Diem to States for Care of Eligible Veterans in State Homes
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: 12/18/2023
	Date Received in OIRA: 10/30/2023
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.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2026	36 Months From Approved	12/31/2023
Responses	2,805	0	11,780
Time Burden (Hours)	2,119	0	5,630
Cost Burden (Dollars)	0	0	0

Abstract: Authority for this information collection is from Title 38 Code of Federal Regulations (CFR) Part 51, Per Diem for Nursing Home, Domiciliary or Adult Day Health Care of Veterans in State Veterans Homes published in the Federal Register as final rule on November 28, 2018 (RIN 2900-A088). This collection of forms is approved under OMB Control Number 2900-0883. These six forms (10-0143, 10-0143A, 10-0144, 10-0144A, 10-0460a and 10-3567) are presented to and completed by State Veterans Homes (SVH) management under Subpart B of the CFR Part 51 and then assessed for compliance to applicable regulations under Subparts D, E or F by VA contracted vendors during a VA survey at each State Veterans Home (SVH) across the U.S. as a regulatory action. This collection of forms falls under the auspices of The Office of Geriatrics and Extended Care in VA Central Office (12GEC). As per VHA Directive 1145.01, this collection of forms is part of the VA survey process. The legal requirements that necessitate this collection of information are found specifically at title 38 CFR Parts §51.31, §51.43 and §51.210 for all three levels of care: nursing home, domiciliary, and adult day health care. VA is requesting to replace VA Form 10-0460 Request for Prescription Drugs from an Eligible Veteran in a State Home with a MS Excel file, 10-0460a, that will document and record any SVH request for VA Medical Center (VAMC) furnished medications or VAMC reimbursement of medications that will identify how the Veteran meets regulatory eligibility criteria specified in §51.43. The MS Excel file will be a monthly exchange of information between the SVH and the VAMC to assure compliance with federal regulations. The MS Excel file, 10-0460a,will take the place of the current VA Form 10-0460.

Authorizing Statute(s): PL: Pub.L. 109 - 461 211(a)(5) Name of Law: Veterans Benefits, Health Care, and Information Technology - Modification to State Home Authorities

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 58439	08/25/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 74247	10/30/2023
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	2,805	11,780	-8,975
Annual Time Burden (Hours)	2,119	5,630	-3,511
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: Yes

Burden Reduction Due to: Changing Forms

Short Statement: The 10-0460 form, which was previously submitted by every individual Veteran, is being replaced with the 10-0460a spreadsheet, which will be submitted once per month for all Veterans per State Home on one spreadsheet. This reduces the burden hours for this collection.

Annual Cost to Federal Government: $138,403

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

View ICR - OIRA Conclusion