2900-AO41 DESIGNEE FOR PATIENT PERSONAL PROPERTY

Forms and Documents

Document Name	Status
Form 10-10118 DESIGNEE FOR PATIENT PERSONAL PROPERTY Form and Instruction	Modified
AO41 PRA Justification to OMB 11-13-14 clean.doc Supporting Statement A	2014-11-17

IC Document Collections

IC ID	Document Title	Status
211131	DESIGNEE FOR PATIENT PERSONAL PROPERTY Form and Instruction	Modified

ICR Details

OMB Control No: 2900-0817	ICR Reference No: 201410-2900-006
Status: Historical Active	Previous ICR Reference No: 201404-2900-004
Agency/Subagency: VA	Agency Tracking No:
Title: 2900-AO41 DESIGNEE FOR PATIENT PERSONAL PROPERTY
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/24/2014
	Date Received in OIRA: 10/10/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2017	36 Months From Approved
Responses	718,000	0	0
Time Burden (Hours)	35,900	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Department of Veterans Affairs (VA) proposes to amend its regulation that governs a competent veteran's designation of a person to receive the veteran's funds and personal effects in the event that such veteran were to die while in a VA medical facility. The proposed rule would eliminate reference to obsolete VA forms, clarify the role of a VA fiduciary for an incompetent veteran-patient, as well as restructure the current regulation for ease of readability.

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Authorizing Statute(s): US Code: 38 USC 8502 Name of Law: null
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
2900-AO41	Final or interim final rulemaking	79 FR 68127	11/14/2014

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 63139	10/23/2013
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
DESIGNEE FOR PATIENT PERSONAL PROPERTY	10-10118	DESIGNEE FOR PATIENT PERSONAL PROPERTY

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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	718,000	0	0	718,000	0	0
Annual Time Burden (Hours)	35,900	0	0	35,900	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: Changing Regulations

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

Burden Reduction Due to:

Short Statement: AO41 is a change in the regulation adding an ICR and increasing burden.

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Annual Cost to Federal Government: $1,206,240

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: 10/10/2014

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