Statement of Accredited Representative in Appealed Case

Forms and Documents

Document Name	Status
Form 646 Statement of Accredited Representative in Appealed Case Form	Modified
2900-0042_justification[1].docx Supporting Statement A	2012-09-27

IC Document Collections

IC ID	Document Title	Status
28158	Statement of Accredited Representative in Appealed Case Form	Modified

ICR Details

OMB Control No: 2900-0042	ICR Reference No: 201205-2900-001
Status: Historical Active	Previous ICR Reference No: 200906-2900-004
Agency/Subagency: VA	Agency Tracking No: 2900-0042
Title: Statement of Accredited Representative in Appealed Case
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/21/2012
	Date Received in OIRA: 09/27/2012
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2015	36 Months From Approved	12/31/2012
Responses	44,551	0	38,604
Time Burden (Hours)	44,551	0	38,604
Cost Burden (Dollars)	0	0	0

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Abstract: The VA Form 646, "Statement of Accredited Representative in Appealed Case," provides a convenient form that an appellant's representative may use to present written argument on behalf of their client in support of an appeal before the Board of Veterans' Appeals.

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Authorizing Statute(s): US Code: 38 USC 7105 Name of Law: Filing of notice of disagreement and appeal
  

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:
	77 FR 127	07/02/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 178	09/13/2012
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
Statement of Accredited Representative in Appealed Case	646	Statement of Accredited Representative Appealed Case

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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	44,551	38,604	0	0	5,947	0
Annual Time Burden (Hours)	44,551	38,604	0	0	5,947	0
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: No

Burden Reduction Due to:

Short Statement: There are no program changes, but there is an adjustment in burden, which reflects an increase in the number of appeals filed by represented appellants.

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Annual Cost to Federal Government: $1,642,310

Does this IC contain surveys, censuses, or employ statistical methods? No

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]? 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? 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: 09/27/2012

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