35% Exemption Request from 85-15 Reporting Requirement (VA Form 22-10216)

Forms and Documents

Document Name	Status
Form VA Form 22-10216 35% exemption Request From 85-15 Reporting Requirement Form	New
2021-22623.pdf Supplementary Document	2021-10-19
2021-16401.pdf Supplementary Document	2021-08-03
Supporting Statement for 22-10216 (85-15) updated.docx Supporting Statement A	2021-09-30

IC Document Collections

IC ID	Document Title	Status
248396	35% exemption Request From 85-15 Reporting Requirement Form	New

ICR Details

OMB Control No:	ICR Reference No: 202107-2900-004
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No: VBA-EDU-NK
Title: 35% Exemption Request from 85-15 Reporting Requirement (VA Form 22-10216)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 10/19/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	1,000	0
Time Burden (Hours)	500	0
Cost Burden (Dollars)	0	0

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Abstract: As part of the benefits authorization process, § 21.4201 places restrictions on enrollment based on the percentage of students receiving financial support in any approved program. These percentages are reported to VA routinely within 30 days of each standard term, semester or quarter, or on a quarterly basis dependent on school type, using VA Form 22-10215. Schools can request an exemption of this reporting requirement through the new from in this collection, VA From 22-10216. VA still requires the school collect the enrollment data, just not report the data to VA on a regular basis . The information requested on VA Form 22-10216 is used to ensure the school is entitled to this reporting exemption and will continue to properly collect the enrollment data.

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Authorizing Statute(s): US Code: 38 USC 38 U.S.C. 3680A(d)
  

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 41536	08/02/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 22623	10/18/2021
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
35% exemption Request From 85-15 Reporting Requirement	VA Form 22-10216	35% Exemption Request From 85-15 Reporting Requirement

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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	1,000	0	0	1,000	0	0
Annual Time Burden (Hours)	500	0	0	500	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a new collection of information.

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Annual Cost to Federal Government: $15,140

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.     No

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: 10/19/2021

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