2900-0600 Justification A 101716

SUPPORTING STATEMENT FOR

REGULATION FOR RECONSIDERATION OF DENIED CLAIMS

2900-0600

A. JUSTIFICATION

1. Explain the circumstances that make the collection of information necessary. Identify legal or administrative requirements that necessitate the collection of information.

Provisions for this data collection are included in 38 C.F.R. 17.133. This informal process provides for submission of a written request for reconsideration denial of healthcare benefits. The request contains the reason the claimant believes the decision is erroneous and allows submission of new and relevant information. This process reduces both formal appeals and allows decision making to be more responsive to Veterans using the VA healthcare system.

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 purpose of this data collection is to provide a vehicle to request an informal review of the denied health care claims of Veterans. Providers, Veterans, and those on behalf of a Veteran such as a Veterans Service Officer, and a person with a Power of Attorney (POA), whose claim reimbursement for healthcare benefits has been denied may initiate this reconsideration request. Hospital administrative personnel will review the new and relevant information to assure an appropriate decision was made on the health care claim and to further alleviate an appeal to the Board.

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 described any consideration of using information technology to reduce burden.

The collection of information does not involve the use of automated, electronic, mechanical, or other technological collection techniques and no specific form or format is required. Additionally, VA determined that automating this data collection is not economically feasible.

4. Describe effort 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.

This is a unique, voluntary, informal process conducted in addition to the formal appeals process. In the event the decision is later appealed, the data gathered will be furnished to the Board of Veterans Affairs as supplemental information. Thus, there is no duplication.

5. If the collection of information impacts small businesses or other small entities, describe any methods used to minimize burden.

No small businesses or other small entities are impacted by this 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.

As this information is collected only when review of a denied claim is requested, VA would not be responsive to the needs of the veteran if the information were collected less frequently.

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 06/22/2016; pages 40769-40770, Volume 81, No. 40769.

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.

An official of a charted Veterans Service Organization suggested this informal information collection.

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 privacy, to the extent permitted by law, provided to respondents and the basis for the assurance in statue, regulation, or agency policy.

Assurances of confidentiality are contained in 38 U.S.C. 5701 and 7332. Respondents are informed that the information collected will become part of the Consolidated Health Record which complies with the Privacy Act of 1974. This data becomes part of the system of records identified as 24VA19 “Patient Medical Record – VA” as set forth in the Compilation of Privacy Act Issuances via online GPO access at http://www.gpoaccess.gov/privacyact/index.html.

11. Provide additional justification for any questions of a sensitive nature, 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. 101,652 respondents x 1 response x 30 minutes per response / 60 = 50,826 burden hours

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 does not include a form. This informal process only requires submission of a written request for reconsideration denial of healthcare benefits

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.

The Bureau of Labor Statistics (BLS) gathers information on full-time wage and salary workers. According to the latest available BLS Current Population Survey (CPS) (http://www.bls.gov/cps/cpsaat39.htm) (dated May 10, 2015), the median weekly earnings of full-time wage and salary workers are $809.00. Assuming a forty (40) hour work week, the median hourly wage is $20.23. VA does not require any additional recordkeeping.

13. Provide an estimate of the total annual cost burden to respondents or record keepers resulting from the collection of information. (Do not include the cost of any hour burden shown in Items 12 and 14).

a. There is no capital, start-up, operation or maintenance costs.

b. Cost estimates are not expected to vary widely. The only cost is that for the time of the respondent.

c. 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 total cost to the Federal Government is estimated to be $4,856,424.30.

	Salary	Responses	Equals	Time	Total Cost
Review	$80.20	101,652	$8,152,490.40	x30 min / 60	$4,076,245.20
Handling	$30.70	101,652	$3,120,716.40	x15 min / 60	$780,179.10
					$4,856,424.30

15. Explain the reason for any program changes or adjustments reported in Items 13 or 14 of OMB 83-I

The adjustment to the annual cost to the Federal Government was based on updates to the hourly rates from what was previously recorded in the 2010 clearance request. The current hourly rate reflects the 2016 Office of Personnel Management GS 13/5 and 5/5 pay. The hourly rate projected for fringe benefits was calculated at one hundred (100%) percent of the FY2016 pay rate and included in the salary rate projected in the above chart.

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.

There are no plans to publish the results of the information collected.

17. If seeking approval to omit the expiration date for OMB approval of the information collection, explain the reasons that display would be inappropriate.

This is not applicable because there is no form involved in this information collection.

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.

B. COLLECTIONS OF INFORMATION EMPLOYING STATISTICAL METHODS

No statistical methods are used in this data collection.

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