Community Residential Care Record Keeping

ICR 201704-2900-009

OMB: 2900-0491

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2018-02-15
IC Document Collections
IC ID
Document
Title
Status
148312
Modified
ICR Details
2900-0491 201704-2900-009
Active 198804-2900-002
VA 2900-0491
Community Residential Care Record Keeping
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 04/27/2018
Retrieve Notice of Action (NOA) 02/15/2018
  Inventory as of this Action Requested Previously Approved
04/30/2021 36 Months From Approved
730 0 0
1,095 0 0
0 0 0

This requirement states that Community Residential Care Facilities maintain a record for each Veteran which contains a copy of the plan of care, emergency notification procedures, and a copy of all signed agreements with the resident.

None
None

Not associated with rulemaking

  82 FR 27332 06/14/2017
82 FR 52971 11/15/2017
No

1
IC Title Form No. Form Name
Community Residential Care Record Keeping

  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 730 0 0 -2,270 0 3,000
Annual Time Burden (Hours) 1,095 0 0 765 0 330
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Changing Regulations
No
Information collection related to the CRC recordkeeping requirement was approved by OMB under OMB control number 2900-0491. This information collection approval expired on July 31, 1990, and was never renewed. However, the recordkeeping requirement continues to be part of the CRC standards, and VA continues to include access and review of those records as an integral part of the CRC inspection process. VA is now requesting reinstatement of the previously approved information collection under control number 2900-0491. The one time per year response estimate remains valid, as the CRC is required to collect this information only one time per year. Burden hours are 0.11 per response. However, the number of estimated respondents has decreased significantly since the original ICR was approved.

$0
No
    No
    No
No
No
No
Uncollected
Cynthia Harvey - Pryor 202 461-5870 cynthia.harvey-pryor@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.
02/15/2018


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