Survey of Veteran Enrollees' Health and Reliance Upon VA

ICR 201212-2900-013

OMB: 2900-0609

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2012-12-26
Supplementary Document
2012-12-26
Supplementary Document
2012-12-26
Supplementary Document
2012-12-26
Supplementary Document
2012-12-26
Supplementary Document
2010-10-19
Supporting Statement A
2012-12-27
Supporting Statement B
2012-12-26
IC Document Collections
ICR Details
2900-0609 201212-2900-013
Historical Active 200902-2900-005
VA 2900-0609
Survey of Veteran Enrollees' Health and Reliance Upon VA
Extension without change of a currently approved collection   No
Regular
Approved without change 02/04/2013
Retrieve Notice of Action (NOA) 12/27/2012
  Inventory as of this Action Requested Previously Approved
02/29/2016 36 Months From Approved 11/30/2013
42,080 0 42,080
14,728 0 14,400
0 0 0

Study of enrollees' health status, income, reliance on VA & interest in Prescription-Only Program will provide information for planning & policy development for actuarial projections of enrollment, utilization, expenditures, mandated annual enrollment reforms, & quantitative & qualitative research.

PL: Pub.L. 104 - 262 Entirety Name of Law: Veterans Health Care Eligibility Reform Act of 1996,
  
None

Not associated with rulemaking

  76 FR 211 11/01/2011
77 FR 50 03/14/2012
No

1
IC Title Form No. Form Name
Survey of Veteran Enrollees' Health and Reliance Upon VA VA Form 10-21034G (CATI) Survey of Veteran Enrollees

  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 42,080 42,080 0 0 0 0
Annual Time Burden (Hours) 14,728 14,400 0 0 328 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The increase in burden was caused by a change in the completion time.

$1,500,000
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Crystal Rennie 202 632-7492 crystal.rennie@va.gov

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
12/27/2012


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