DoD Referral to Integrated Disability Evaluation System (IDES) (VA Form 21-0819)

Forms and Documents

Document Name	Status
Form 21-0819 DoD Referral to Integrated Disability Evaluation System (IDES) (VA Form 21-0819) Form	Modified
30-Day FRN - 2900-0704 (2018).pdf Supplementary Document	2018-03-27
2018-00233, 60-Day FRN (2900-0704).pdf Supplementary Document	2018-03-14
2900-0704 Supporting Stmt (VAF 21-0819) Final.docx Supporting Statement A	2018-07-02

IC Document Collections

IC ID	Document Title	Status
181456	DoD Referral to Integrated Disability Evaluation System (IDES) (VA Form 21-0819) Form	Modified

ICR Details

OMB Control No: 2900-0704	ICR Reference No: 201803-2900-003
Status: Active	Previous ICR Reference No: 201508-2900-010
Agency/Subagency: VA	Agency Tracking No: VBA-COMP-YA
Title: DoD Referral to Integrated Disability Evaluation System (IDES) (VA Form 21-0819)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 07/06/2018
	Date Received in OIRA: 04/18/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2021	36 Months From Approved	07/31/2019
Responses	14,000	0	14,000
Time Burden (Hours)	3,500	0	7,000
Cost Burden (Dollars)	0	0	0

---

Abstract: This form is used in a joint effort between VA and the Department of Defense (DoD), as recommended by former President Bush’s Interagency Task Force on Returning Global War on Terror Heroes, to determine an injured or ill Global War on Terrorism (GWOT) service member’s military readiness fitness for military retention, level of disability for retirement, and VA Disability compensation. VA Form 21-0819 has been updated, to include: • A new title. • New standardization data points; to include optical character recognition boxes. This is a non-substantive change. • The burden has been decreased from 30 to 15 minutes.

---

Authorizing Statute(s): US Code: 38 USC 5101 Name of Law: Veteran's Benefits
  

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:
	83 FR 1285	01/10/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 12082	03/19/2018
Did the Agency receive public comments on this ICR? Yes

---

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

IC Title	Form No.	Form Name
DoD Referral to Integrated Disability Evaluation System (IDES) (VA Form 21-0819)	21-0819	DoD Referral to Integrated Disability Evaluation System (IDES)

---

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	14,000	14,000	0	0	0	0
Annual Time Burden (Hours)	3,500	7,000	0	-3,500	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: 1. The respondent burden has been decreased in half; from 30 to 15 minutes. 2. VA Form 21-0819 has been updated, to include: • A new title. • New standardization data points; to include optical character recognition boxes. However, this change is non-substantive.

---

Annual Cost to Federal Government: $609,963

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: 04/18/2018

---