Authorization and Certification of Entrance or Reentrance into Rehabilitation and Certification of Status (VA Form 28-1905)

Forms and Documents

Document Name	Status
Form VA Form 28-1905 Authorization and Certification of Entrance or Reentrance into Rehabilitation and Certification of Status (28-1905) Form	Modified
2019-07974.pdf Supplementary Document	2019-04-23
2019-02136.pdf Supplementary Document	2019-02-27
SupportingStatement(2900-0014).docx Supporting Statement A	2019-02-27

IC Document Collections

IC ID	Document Title	Status
28099	Authorization and Certification of Entrance or Reentrance into Rehabilitation and Certification of Status (28-1905) Form	Modified

ICR Details

OMB Control No: 2900-0014	ICR Reference No: 201708-2900-033
Status: Historical Inactive	Previous ICR Reference No: 201403-2900-017
Agency/Subagency: VA	Agency Tracking No: VBA-VR&E-NK
Title: Authorization and Certification of Entrance or Reentrance into Rehabilitation and Certification of Status (VA Form 28-1905)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Not subject to PRA	Conclusion Date: 01/13/2020
	Date Received in OIRA: 06/04/2019
Terms of Clearance: The Department of Veterans Affairs shall remove the OMB control number and PRA burden statement for this form because it is used to collect information from VA employees only.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The VA Form 28-1905 is used by a VA case manager, who completes sections A and B and sends the form to the veteran's or other eligible person's training facility or service provider. The facility or service provider then completes section C to verify to VA that the individual has entered the planned program. The facility uses a copy for voucher purposes.

---

Authorizing Statute(s): US Code: 38 USC 3108 Name of Law: Allowances
   US Code: 38 USC 3680(g) Name of Law: Payment of educational assistance or subsistence
   US Code: 38 USC 501(a) Name of Law: Rules and regulations
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 2136	02/13/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 7974	04/22/2019
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Authorization and Certification of Entrance or Reentrance into Rehabilitation and Certification of Status (28-1905)	VA Form 28-1905	Authorization and Certification of Entrance or Reentrance into Rehabilitation and Certification of Status

---

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

---

Annual Cost to Federal Government: $695,700

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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

---

Common Form ICR:  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:

(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: 06/04/2019

---