Open Burn Pit Registry Web-accessible Self-Assessment/Questionnaire

Forms and Documents

Document Name	Status
Form VA Form 10-10066 Airborne Hazards And Open Burn Pit Registry Self-Assessment Questionnaire Form	New
Form VA Form 10-10066 Open Burn Pit Registry Airborne Hazard Web-Accessible Self-Assessment/ Form	Removed
Open Burn Pit Registry - Recruitment_Promotion_20140326.docx Supplementary Document	2014-03-26
Part A - Burn Pit - OMB Comments_PC_20140319_clean WC.docx Supporting Statement A	2014-03-25
Part B - Burn Pit - OMB Comments_20140326.docx Supporting Statement B	2014-03-26
Updated FRN extending legal authority for eligibility 1-23-14.docx Supplementary Document	2014-01-23

IC Document Collections

IC ID	Document Title	Status
210929	Airborne Hazards And Open Burn Pit Registry Self-Assessment Questionnaire Form	New
206906	Open Burn Pit Registry Airborne Hazard Web-Accessible Self-Assessment/ Form	Removed

ICR Details

OMB Control No: 2900-0800	ICR Reference No: 201401-2900-002
Status: Historical Active	Previous ICR Reference No: 201305-2900-007
Agency/Subagency: VA	Agency Tracking No:
Title: Open Burn Pit Registry Web-accessible Self-Assessment/Questionnaire
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: 03/26/2014
	Date Received in OIRA: 01/28/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2017	36 Months From Approved
Responses	50,000	0	0
Time Burden (Hours)	33,333	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Public Law 112-260 Section 201, enacted by President Obama on 10 January 2013, requires VA to establish and maintain an "Open Burn Pit Registry" no later than one year from enactment. The Secretary of Veterans Affairs may "include any information in such registry that the Secretary of Veterans Affairs determines necessary to ascertain and monitor the health effects of the exposure of members of the Armed Forces to toxic airborne chemicals and fumes caused by open burn pits".

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Authorizing Statute(s): PL: Pub.L. 112 - 260 201 Name of Law: Establishment of Open Burn Pit Registry
  

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:
	12 FR 1234	01/28/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	12 FR 1234	01/28/2014
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Open Burn Pit Registry Airborne Hazard Web-Accessible Self-Assessment/	VA Form 10-10066	Open Pit Burn Registry Web-accessible Self-Assessment/Questionnaire
Airborne Hazards And Open Burn Pit Registry Self-Assessment Questionnaire	VA Form 10-10066	Airborne Hazards And Open Burn Pit Registry Self-Assessment Questionnaire

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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	50,000	0	0	50,000	0	0
Annual Time Burden (Hours)	33,333	0	0	33,333	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.

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Annual Cost to Federal Government: $2,170,000

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]? 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? 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: 01/28/2014

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