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 10-15-15 update 2-2-2016.docx Supporting Statement A	2016-02-03
2900-0042 60-day notice.docx Supplementary Document	2015-08-05

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: 201507-2900-003
Status: Historical Active	Previous ICR Reference No: 201205-2900-001
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 with change	Conclusion Date: 02/05/2016
	Date Received in OIRA: 11/25/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2019	36 Months From Approved	02/29/2016
Responses	50,286	0	44,551
Time Burden (Hours)	50,286	0	44,551
Cost Burden (Dollars)	0	0	0

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Abstract: 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 80 FR 48138 on August 11, 2015.

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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:
	80 FR 48138	08/11/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 72787	11/20/2015
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	50,286	44,551	0	5,735	0	0
Annual Time Burden (Hours)	50,286	44,551	0	5,735	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: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: There is an adjustment in burden, which reflects an increase in the number of appeals filed by represented appellants. 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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Annual Cost to Federal Government: $1,872,108

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: 11/25/2015

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