Internet Student CPR Web Registration Application
VA Form 10-0468
OMB FORM 2900-XXXX
1. Explain the circumstances that make the collection of information necessary. Identify legal or administrative requirements that necessitate the collection of information.
The Minneapolis VA Medical Center Education Service has contracted with the American Heart Association to operate a Community Training Center to provide Cardiopulmonary Resuscitation (CPR), Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS) courses to VA employees and volunteers, University of Minnesota Residents and community students. This request is to seek Office of Management and Budget (OMB) approval in establishing an online web registration application. The CPR Web Registration form (VA Form 10-0468) only requests the name, mailing address, phone number, military status and position (Dr, RN, etc.) of the student. This information will not be viewable for other students. Social Security numbers, financial data or any other personal information is not being requested. The AHA course rosters will be used to identify who attends AHA courses and asks for the name, mailing address and contact phone number for each student. Legal authority for this data collection is found under 38 UCS, Part I, Chapter 5, Section 527 that authorizes the collection of data that will allow measurement and evaluation of the Department of Veterans Affairs Programs, the goal of which is improved health care services.
2. Indicate how, by whom, and for what purposes the information is to be used; indicate actual use the agency has made of the information received from current collection.
The web registration information will be used to identify students attending courses provided by the MVAMC Education Service. The rosters will help the Registrar create Certificates of Training, contact students for changes in courses, and provide a mailing address to mail Certificates of Training to, if these are not provided at the end of training. No other contact will be made with students before or after a course except for those reasons. There will be no mailing lists created or shared with any other VA entity, the AHA or other agency, based on receipt of this information. The Registrar is the AHA CTC Training Coordinator and author of this request, Dr. David Adriansen, (612) 306-8232, VHA Employee, MVAMC Education Service.
3. Describe whether, and to what extent, the collection of information involves the use of automated, electronic, mechanical, or other technological collection techniques or other forms of information technology, e.g. permitting electronic submission of responses, and the basis for the decision for adopting this means of collection. Also describe any consideration of using information technology to reduce burden.
The use of Internet/Intranet web registration for community, University Residents, military and VA students could eliminate approximately 4,500 possible registration calls per year to the Registrar (one person). This request will expedite the process for the public in quickly identifying and registering for a training course online without having to wait for the Registrar to return calls or e-mails to answer their questions. Web registration streamlines the entire process.
4. Describe efforts to identify duplication. Show specifically why any similar information already available cannot be used or modified for use for the purposes described in Item 2 above.
The only method in obtaining this information would be telecommunication registration via the Registrar. Each request is estimated on an average of 2-3 contacts with return calls or e-mails, confirming course registrations, and providing information on course registration and course reporting instructions. Web registration streamlines the entire process, does not have any duplication, and will provide an electronic record of training and individual course records for filing with course final exam answer sheets.
5. If the collection of information impacts small businesses or other small entities, describe any methods used to minimize burden.
These are applications for individual benefits, no small businesses or other small entities are impacted by the information collection
6. Describe the consequences to Federal program or policy activities if the collection is not conducted or is conducted less frequently as well as any technical or legal obstacles to reducing burden.
VA would not be responsive to the needs of course students.
7. Explain any special circumstances that would cause an information collection to be conducted more often than quarterly or require respondents to prepare written responses to a collection of information in fewer than 30 days after receipt of it; submit more than an original and two copies of any document; retain records, other than health, medical, government contract, grant-in-aid, or tax records for more than three years; in connection with a statistical survey that is not designed to produce valid and reliable results that can be generalized to the universe of study and require the use of a statistical data classification that has not been reviewed and approved by OMB.
There are no such special circumstances.
8. a. If applicable, provide a copy and identify the date and page number of publication in the Federal Register of the sponsor’s notice, required by 5 CFR 1320.8(d), soliciting comments on the information collection prior to submission to OMB. Summarize public comments received in response to that notice and describe actions taken by the sponsor in responses to these comments. Specifically address comments received on cost and hour burden.
The notice of Proposed Information Collection Activity was published in the Federal Register on September 9, 2009, page 46485. We received no comments in response to this notice.
b. Describe efforts to consult with persons outside the agency to obtain their views on the availability of data, frequency of collection, clarity of instructions and recordkeeping, disclosure or reporting format, and on the data elements to be recorded, disclosed or reported. Explain any circumstances which preclude consultation every three years with representatives of those from whom information is to be obtained.
Registration information is required to complete American Heart Association Course Records, which has to be maintained for two years before local destruction. Course Records will be created on Excel spread sheets by the Training Coordinator and saved as a “database” on his VA workstation. Course records are subject to review during annual AHA Reviews. The AHA is a nonprofit agency and does not direct or provide policy on how information is gathered or recorded for course records. The AHA only requires that the records with the student’s name, mailing address and contact phone number are completed and on file with the AHA Training Center.
Outside consultation is also conducted with the public through the 60- and 30-day Federal Register notices.
9. Explain any decision to provide any payment or gift to respondents, other than remuneration of contractors or grantees.
No payment or gift is provided to respondents.
10. Describe any assurance of confidentiality provided to respondents and the basis for the assurance in statute, regulation, or agency policy.
Respondents will input their name, e-mail address and contact phone number online via the Web Registration Site. Respondents will only be able to view their data and then receive a confirmation e-mail message that they are enrolled in the course. There will be no ability to view other respondents’ names, addresses or phone numbers. This information will be temporarily stored as part of the VA system of records 57VA125, Voluntary Service.
11. Provide additional justification for any questions of a sensitive nature (Information that, with a reasonable degree of medical certainty, is likely to have a serious adverse effect on an individual's mental or physical health if revealed to him or her), such as sexual behavior and attitudes, religious beliefs, and other matters that are commonly considered private; include specific uses to be made of the information, the explanation to be given to persons from whom the information is requested, and any steps to be taken to obtain their consent.
There are no questions of a sensitive nature.
12. Estimate of the hour burden of the collection of information:
a. The number of respondents, frequency of responses, annual burden, and explanation for each form is reported as follows:
It is estimated that the average student can complete an online application for training in five minutes with reading how to register, entering name, e-mail address and phone number and receiving a course confirmation.
VA Form |
No. of respondents |
x No. of responses |
x Min. |
Total |
/ by 60
|
Number |
10-0468 |
1,500 |
1 |
5 |
7,500 |
125 |
b. If this request for approval covers more than one form, provide separate hour burden estimates for each form and aggregate the hour burdens in Item 13 of OMB 83-I.
This request covers only one form.
c. Provide estimates of annual cost to respondents for the hour burdens for collections of information. The cost of contracting out or paying outside parties for information collection activities should not be included here. Instead, this cost should be included in Item 14.
We do not require any additional recordkeeping. There is no appreciable cost to the respondents for completing this online form on one occasion.
13. Provide an estimate of the total annual cost burden to respondents or recordkeepers resulting from the collection of information. (Do not include the cost of any hour burden shown in Items 12 and 14).
a. Cost estimates are not expected to vary widely. The only cost is that for the time of the respondent.
b. There is no anticipated recordkeeping burden.
14. Provide estimates of annual cost to the Federal Government. Also, provide a description of the method used to estimate cost, which should include quantification of hours, operation expenses (such as equipment, overhead, printing, and support staff), and any other expense that would not have been incurred without this collection of information. Agencies also may aggregate cost estimates from Items 12, 13, and 14 in a single table.
The cost to the Federal Government is negligible.
15. Explain the reason for any burden hour changes since the last submission.
This is a new collection and all burden hours are considered a program increase.
16. For collections of information whose results will be published, outline plans for tabulation and publication. Address any complex analytical techniques that will be used. Provide the time schedule for the entire project, including beginning and ending dates of the collection of information, completion of report, publication dates, and other actions.
This data will not be published.
17. If seeking approval to omit the expiration date for OMB approval of the information collection, explain the reasons that display would be inappropriate.
VA seeks to minimize the cost to itself of collecting, processing and using the information by not displaying an expiration date. VA seeks an exemption that waives the displaying of the expiration date on this VA Form. The VA Form may be reproduced by the respondents and VA field facilities from the Internet and then stocked. If we are required to display an expiration date, it would result in unnecessary waste of existing stock of the forms. Inclusion of the expiration date would place an unnecessary burden on the respondent (since they would find it necessary to obtain a newer version, while VA would have accepted the old one).
18. Explain each exception to the certification statement identified in Item 19, “Certification for Paperwork Reduction Act Submissions,” of OMB 83-I.
There are no exceptions.
No statistical methods are used in this data collection.
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| File Type | application/msword |
| File Title | Bold black = OMB questions |
| Author | vhacobickoa |
| File Modified | 2009-12-14 |
| File Created | 2009-12-14 |