Pre and Post Independent Living Assessment (VA Form 28-0791)

Forms and Documents

Document Name	Status
Form 28-0791 Pre and Post Independent Living Assessment (VA Form 28-0791) Form and Instruction	Modified
30-DAY (published) 2900-0681.pdf Supplementary Document	2024-10-11
60-DAY FRN (published) 2900-0681.pdf Supplementary Document	2024-10-07
2900-0681 Supportive Statement VAF 28-0791 (3).docx Supporting Statement A	2024-10-11

IC Document Collections

IC ID	Document Title	Status
44130	Pre and Post Independent Living Assessment (VA Form 28-0791) Form and Instruction	Modified

ICR Details

OMB Control No: 2900-0681	ICR Reference No: 202404-2900-018
Status: Received in OIRA	Previous ICR Reference No: 201412-2900-010
Agency/Subagency: VA	Agency Tracking No: VBA-VRE-KM
Title: Pre and Post Independent Living Assessment (VA Form 28-0791)
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: 10/11/2024

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	906	0
Time Burden (Hours)	906	0
Cost Burden (Dollars)	0	0

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Abstract: VA Form 28-0791, Pre and Post Independent Living Assessment (IL) is used by the Vocational Rehabilitation Counselor (VRC) during the initial and post IL evaluations. During this face-to-face meeting, the VRC identifies impairments and or barriers the Veteran may be experiencing with Activities of Daily Living (ADLs). The VRC then uses this information to identify the needs for services. The VRC compares the information obtained from the preliminary and post plan assessments to determine if there are improvements in the Veteran’s activities of daily living. Without the information gathered on this form, VR&E is not able to identify IL needs and provide needed services. There are no other invitations or other communications sent to the respondent associated with the information collection. Failure to collect this information would have a detrimental impact upon the determination of appropriate rehabilitation goals for Veterans participating in the IL program. This would negatively impact the Veteran’s participation in his or her rehabilitation program.

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Authorizing Statute(s): US Code: 38 USC 3104(a)(1) Name of Law: Scope of services and assistance
   US Code: 38 USC 3109 Name of Law: Entitlement to independent living services and assistance
   US Code: 38 USC 3120 Name of Law: Program of independent living services and assistance
   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:
	89 FR 57996	07/16/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 82677	10/11/2024
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
Pre and Post Independent Living Assessment (VA Form 28-0791)	28-0791	Pre and Post Independent Living Assessment

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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	906	0	0	-1,594	0	2,500
Annual Time Burden (Hours)	906	0	0	-1,594	0	2,500
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: The burden decreased due to a revision of the information collection.

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Annual Cost to Federal Government: $125,720

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: 10/11/2024

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