Appeal to Board of Veterans' Appeals, VA Form 9; Withdrawal of Services by a Representative; Requests for Changes in Hearing Date; Motions for Reconsideration

Forms and Documents

Document Name	Status
Form VA Form 9 Appeal to Board of Veterans' Appeals, VA Form 9; Withdrawal of Services by a Representative; Requests for Changes in Hearing Date; Motions for Reconsideration Form	Modified
2015 Supporting Statement 2900-0085_06-10-2015 final.docx Supporting Statement A	2015-06-29
OMB 2900-0085 VA Form Exlpanation of Changes 5-27-15.doc Supplementary Document	2015-05-28
White Paper.docx Supplementary Document	2015-05-22
May 2015-Explanation of Revisions - Form 9.docx Supplementary Document	2015-05-22

IC Document Collections

IC ID	Document Title	Status
28235	Appeal to Board of Veterans' Appeals, VA Form 9; Withdrawal of Services by a Representative; Requests for Changes in Hearing Date; Motions for Reconsideration Form	Modified

ICR Details

OMB Control No: 2900-0085	ICR Reference No: 201407-2900-004
Status: Historical Active	Previous ICR Reference No: 201107-2900-015
Agency/Subagency: VA	Agency Tracking No: 2900-0085
Title: Appeal to Board of Veterans' Appeals, VA Form 9; Withdrawal of Services by a Representative; Requests for Changes in Hearing Date; Motions for Reconsideration
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/09/2015
	Date Received in OIRA: 06/02/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2018	36 Months From Approved
Responses	58,602	0	0
Time Burden (Hours)	59,770	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The information required is used in processing appeals for denial of VA benefits. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. The Federal Register Notice with a 60-day comment period soliciting comments on this collection of information was published at 79 FR 71506-07, December 2, 2014.

---

Authorizing Statute(s): US Code: 38 USC 7105(a) Name of Law: Filing of notice of disagreement and appeal
   US Code: 38 USC 7107 Name of Law: Appeals: dockets; hearings
   US Code: 38 USC 5901 Name of Law: Prohibition against acting as claims agent or attorney
   US Code: 38 USC 5902 Name of Law: Recognition of representatives of organizations
   US Code: 38 USC 7103 Name of Law: Reconsideration; correction of obvious errors
   US Code: 38 USC 5903 Name of Law: Recognition with respect to particular claims
   US Code: 38 USC 5904 Name of Law: Recognition of agents and attorneys generally
   US Code: 38 USC 5905 Name of Law: Penalty for certain acts
   US Code: 38 USC 7104 Name of Law: Jurisdiction of the Board
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 71506	12/02/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 8952	02/19/2015
Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Appeal to Board of Veterans' Appeals, VA Form 9; Withdrawal of Services by a Representative; Requests for Changes in Hearing Date; Motions for Reconsideration	VA Form 9	Appeal to Board of Veterans' Appeals

---

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	58,602	0	0	5,661	0	52,941
Annual Time Burden (Hours)	59,770	0	0	8,829	0	50,941
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: There are no program changes. Adjustments reflect an increase in the number of respondents/appeal forms filed with the VA annually. Also, the number of hearings held increased, in part, due to the increased use of video-conference hearings. Calculations were adjusted to take into account respondent burden for additional Services included under supporting statement no. 12. Additionally, the expiration date has been added to the form.

---

Annual Cost to Federal Government: $2,189,348

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

---

Common Form ICR:  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:

(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: 06/02/2015

---