National Health Survey of Gulf War Era Veterans and Their Families Phase III Physical Examinations

Forms and Documents

Document Name	Status

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Document Title	Status
28835	National Health Survey of Gulf War Era Veterans and Their Families Phase III Physical Examinations	Migrated

ICR Details

OMB Control No: 2900-0598	ICR Reference No: 199807-2900-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No:
Title: National Health Survey of Gulf War Era Veterans and Their Families Phase III Physical Examinations
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 08/15/1998
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/15/1998
	Date Received in OIRA: 07/14/1998
Terms of Clearance: Approved for use on an emergency basis through 3/99 under the conditions that: 1)for the public record, VA submits to OMB all revised forms, instructions, and Supporting Statements consistent with commitments made in its 9/9/98 correspondence with the exception of the next two points; 2) VA amends its commitment in Question 1 to clarify that pediatric exams will not be performed in VA hospitals. The original sentence should be revised to account for local medical contacts, i.e. "The examinations will be performed at VA Medical Centers with pediatric contracts from affiliated universities or local medical offices"; 3) consistent with OMB Directive15, VA amends its race/ ethnicity question to include an ethnicity question separate and preliminary to the race question. In addition, in lieu of the "Other (specify)" category, VA should allow respondents to select "one or more" racial categories; and 4) VA provides OMB a more detailed justification of reimbursement, including an explanation of the response rate impacts of alternative lower or higher reimbursements.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/1999	03/31/1999
Responses	1	0	0
Time Burden (Hours)	54,920	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Physicians within and outside the VA hospital system will use the information collected during Phase III to aid in diagnosing and treating Gulf War Veterans.

Emergency Justfication:

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:

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Federal Register Notices & Comments

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
National Health Survey of Gulf War Era Veterans and Their Families Phase III Physical Examinations

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ICR Summary of Burden

	Total Approved	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	0	0	1	0	0
Annual Time Burden (Hours)	54,920	0	0	54,920	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:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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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: 07/14/1998

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