Claim for Reimbursement of Travel Expenses (VA Form 28-0968)

Forms and Documents

Document Name	Status
Form VAF 28-0968 Claim for Reimbursement of Travel Expenses (VA Form 28-0968) Form and Instruction	Modified
30-Day FRN.pdf Supplementary Document	2021-05-04
Final 60-Day FRN.pdf Supplementary Document	2021-04-27
2900-0830 SS (VAF 28-0968)4.27.21.docx Supporting Statement A	2021-04-27

IC Document Collections

IC ID	Document Title	Status
212603	Claim for Reimbursement of Travel Expenses (VA Form 28-0968) Form and Instruction	Modified

ICR Details

OMB Control No: 2900-0830	ICR Reference No: 202102-2900-003
Status: Received in OIRA	Previous ICR Reference No: 201408-2900-003
Agency/Subagency: VA	Agency Tracking No: VBA-VR&E-MS
Title: Claim for Reimbursement of Travel Expenses (VA Form 28-0968)
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/05/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	113,000	0
Time Burden (Hours)	9,417	0
Cost Burden (Dollars)	0	0

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Abstract: VA Form 28-0968 is used to collect information for claimants to apply for the mileage reimbursement benefit in an efficient, convenient and accurate manner. VBA must determine the identity of the claimant; the dates and length of the trip being claimed, based on the claimant's residence and the place of evaluation and counseling, or other place in connection with vocational rehabilitation services; and whether expenses other than mileage are being claimed.

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Authorizing Statute(s): US Code: 38 USC 111 Name of Law: Payments or allowances for beneficiary travel
   US Code: 38 USC 501(a) Name of Law: Rules and Regulations
  

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:
	86 FR 11054	02/23/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 23493	05/03/2021
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
Claim for Reimbursement of Travel Expenses (VA Form 28-0968)	VAF 28-0968	Claim for Reimbursement of Travel Expenses

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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	113,000	0	0	-16,000	0	129,000
Annual Time Burden (Hours)	9,417	0	0	-1,333	0	10,750
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: Counselors are now able to meet with claimants via Tele-counseling which reduces the number of claimants that travel to VR&E offices, or other places, for counseling and evaluation in connection with vocational rehabilitation services and will need reimbursed for mileage incurred expenses for travel.

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Annual Cost to Federal Government: $6,055,158

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: 05/05/2021

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