Per Diem to States for Care of Eligible Veterans in State Homes

ICR 202306-2900-012

OMB: 2900-0883

Federal Form Document

ICR Details
2900-0883 202306-2900-012
Received in OIRA 202005-2900-011
VA 2900-0883
Per Diem to States for Care of Eligible Veterans in State Homes
Revision of a currently approved collection   No
Regular 10/30/2023
  Requested Previously Approved
36 Months From Approved 11/30/2023
2,805 11,780
2,119 5,630
0 0

Authority for this information collection is from Title 38 Code of Federal Regulations (CFR) Part 51, Per Diem for Nursing Home, Domiciliary or Adult Day Health Care of Veterans in State Veterans Homes published in the Federal Register as final rule on November 28, 2018 (RIN 2900-A088). This collection of forms is approved under OMB Control Number 2900-0883. These six forms (10-0143, 10-0143A, 10-0144, 10-0144A, 10-0460a and 10-3567) are presented to and completed by State Veterans Homes (SVH) management under Subpart B of the CFR Part 51 and then assessed for compliance to applicable regulations under Subparts D, E or F by VA contracted vendors during a VA survey at each State Veterans Home (SVH) across the U.S. as a regulatory action. This collection of forms falls under the auspices of The Office of Geriatrics and Extended Care in VA Central Office (12GEC). As per VHA Directive 1145.01, this collection of forms is part of the VA survey process. The legal requirements that necessitate this collection of information are found specifically at title 38 CFR Parts §51.31, §51.43 and §51.210 for all three levels of care: nursing home, domiciliary, and adult day health care. VA is requesting to replace VA Form 10-0460 Request for Prescription Drugs from an Eligible Veteran in a State Home with a MS Excel file, 10-0460a, that will document and record any SVH request for VA Medical Center (VAMC) furnished medications or VAMC reimbursement of medications that will identify how the Veteran meets regulatory eligibility criteria specified in §51.43. The MS Excel file will be a monthly exchange of information between the SVH and the VAMC to assure compliance with federal regulations. The MS Excel file, 10-0460a,will take the place of the current VA Form 10-0460.

PL: Pub.L. 109 - 461 211(a)(5) Name of Law: Veterans Benefits, Health Care, and Information Technology - Modification to State Home Authorities
  
None

Not associated with rulemaking

  88 FR 58439 08/25/2023
88 FR 74247 10/30/2023
No

  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 2,805 11,780 0 -8,975 0 0
Annual Time Burden (Hours) 2,119 5,630 0 -3,511 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Changing Forms
The 10-0460 form, which was previously submitted by every individual Veteran, is being replaced with the 10-0460a spreadsheet, which will be submitted once per month for all Veterans per State Home on one spreadsheet. This reduces the burden hours for this collection.

$138,403
No
    Yes
    Yes
No
No
No
No
Frances O'Donnell 703 405-2449 fran.odonnell@cathexiscorp.com

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
10/30/2023


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