Decision Review Request: Higher Level Review (VA Form 20-0996)

Forms and Documents

Document Name	Status
Form 20-0996 Request for Higher-Level Review (PL 115-55) (VA Form 20-0996) Form	Modified
OMB-30-Day FR Notice - 0996.pdf Supplementary Document	2021-02-22
60-Day FRN - 2900-0862 (2020).pdf Supplementary Document	2020-12-15
2900-0862 Supporting Statement 20-0996_FEB2021.docx Supporting Statement A	2021-02-10

IC Document Collections

IC ID	Document Title	Status
232032	Request for Higher-Level Review (PL 115-55) (VA Form 20-0996) Form	Modified

ICR Details

OMB Control No: 2900-0862	ICR Reference No: 202011-2900-002
Status: Received in OIRA	Previous ICR Reference No: 201901-2900-005
Agency/Subagency: VA	Agency Tracking No: VBA-OAR-YA
Title: Decision Review Request: Higher Level Review (VA Form 20-0996)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 02/25/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	02/28/2022
Responses	85,500	115,000
Time Burden (Hours)	21,375	28,750
Cost Burden (Dollars)	0	0

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Abstract: VA Form 20-0996, Decision Review Request: Higher-Level Review, is used by a claimant and/or beneficiary to formally request a Higher-Level Review of an initial VA decision, in accordance with the Appeals Modernization Act. The information collected is used by VA to identify the issues in dispute which the claimant seeks review of in the Higher-Level Review Lane. Additionally, the information collected is used to schedule a telephonic informal conference, when requested.

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Authorizing Statute(s): US Code: 38 USC 5104B Name of Law: Higher-level review by the agency of original jurisdiction
   PL: Pub.L. 115 - 55 2 Name of Law: Veterans Appeals Improvement and Modernization Act of 2017
  

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:
	85 FR 81287	12/15/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 10168	02/18/2021
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Request for Higher-Level Review (PL 115-55) (VA Form 20-0996)	20-0996	DECISION REVIEW REQUEST: HIGHER-LEVEL REVIEW

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ICR Summary of Burden

	Total Request	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	85,500	115,000	0	-29,500	0	0
Annual Time Burden (Hours)	21,375	28,750	0	-7,375	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: This collection previously had two forms. At this time we are separating them, hence the burden has been decreased from 30 minutes to 15 minutes.

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Annual Cost to Federal Government: $4,932,837

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? No

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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: 02/25/2021

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