Operation Enduring Freedom/Operation Iraqi Freedom Veterans Health Needs Assessment Survey

Forms and Documents

Document Name	Status
Form VA Form Number 10- Operation Enduring Freedom/Operation Iraqi Freedom Veterans Health Needs Assessment Survey Form and Instruction	New
VA Response EF.doc Supplementary Document	2009-04-16
followup.letter03.30.09.trk.doc Supplementary Document	2009-04-16
Survey Protocol 3 30 09 underline.kst.doc Supplementary Document	2009-04-16
advance letter03.30.09.trk.doc Supplementary Document	2009-04-16
Survey Protocol 3 30 09 underline.kst.doc Supplementary Document	2009-04-16
Supporting Statement B (V3).doc Supporting Statement B	2008-09-08
VA Form 10-21091.doc Supporting Statement A	2008-11-20
VA Cover Letter (sample).pdf Supplementary Document	2008-08-15

IC Document Collections

IC ID	Document Title	Status
186170	Operation Enduring Freedom/Operation Iraqi Freedom Veterans Health Needs Assessment Survey Form and Instruction	New

ICR Details

OMB Control No: 2900-0728	ICR Reference No: 200808-2900-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No:
Title: Operation Enduring Freedom/Operation Iraqi Freedom Veterans Health Needs Assessment Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 05/03/2009
	Date Received in OIRA: 11/20/2008
Terms of Clearance: Approved consistent with revisions submitted by VA and included in the docket.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2012	36 Months From Approved
Responses	3,000	0	0
Time Burden (Hours)	1,000	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The work of the VA Mid-Atlantic Region's Mental Illness Research, Education and Clinical Center is focused on identifying, refining and disseminating best practices for assisting returning war zone veterans and their families who are facing general readjustment issues and often clinical problems such as Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI). This needs assessment will also support compliance in providing access for mental health and the use of mental health supplemental facilities funding. The needs, concerns and health care preferences for VA services among this group of veterans have largely been inferred from medical records, without direct input from veterans. The proposed regional needs assessment survey will provide this important direct input, will help guide Veterans Integrated Service Network (VISN) VISN 6 program development and will pilot the survey instrument for a future national effort.

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Authorizing Statute(s): US Code: 38 USC Part 1, Chapter 5, Section 527 Name of Law: Veterans Benefits, Evaluation and Data Collection
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 177	09/11/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 224	11/19/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Operation Enduring Freedom/Operation Iraqi Freedom Veterans Health Needs Assessment Survey	VA Form Number 10-21091	Operation Enduring Freedom/Operation Iraqi Freedom Veterans Health Needs Assessment

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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	3,000	0	0	3,000	0	0
Annual Time Burden (Hours)	1,000	0	0	1,000	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: No

Burden Reduction Due to:

Short Statement: This is a new collection and all burden hours are considered a program increase.

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Annual Cost to Federal Government: $48,471

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 11/20/2008

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