Veterans Health Benefits Handbook Satisfaction Survey

Forms and Documents

Document Name	Status
Form 10-0507 Veterans Health Benefits Handbook Satisfaction Survey Form and Instruction	Modified
White Paper Handbook Feb 2016.docx Supplementary Document	2016-02-04
VHA_SENT_VE_Non_Substantial_Change_White Paper 12 28 15 _ Final - 1.4.16.docx Justification for No Material/Nonsubstantive Change	2016-07-08
HB Survey Justification A_062216 2900-0773_VE.docx Supporting Statement A	2016-06-22
HB Survey Justification B_061216 v2.docx Supporting Statement B	2016-06-22

IC Document Collections

IC ID	Document Title	Status
194426	Veterans Health Benefits Handbook Satisfaction Survey Form and Instruction	Modified

ICR Details

OMB Control No: 2900-0773	ICR Reference No: 201601-2900-012
Status: Historical Active	Previous ICR Reference No: 201403-2900-011
Agency/Subagency: VA	Agency Tracking No: 2900-0773
Title: Veterans Health Benefits Handbook Satisfaction Survey
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/12/2016
	Date Received in OIRA: 07/08/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2017	10/31/2017	10/31/2017
Responses	1,622	0	1,622
Time Burden (Hours)	135	0	135
Cost Burden (Dollars)	0	0	0

---

Abstract: The Veterans' Health Benefits Handbook will contain general eligibility and benefits information and most importantly, information specific to the recipient. VHA hopes to provide Veterans an opportunity to give anonymous feedback on the content and presentation of this material. VHA will use the information gathered to determine how well the Handbook meets Veterans' needs and make changes to the Handbook where needed.

---

Authorizing Statute(s): EO: EO 12862 Name/Subject of EO: Setting Customer Service Standards
  

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 19417	04/08/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 36583	06/27/2014
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
Veterans Health Benefits Handbook Satisfaction Survey	10-0507	Veterans Health Benefits Handbook Satisfaction Survey

---

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	1,622	1,622	0	0	0	0
Annual Time Burden (Hours)	135	135	0	0	0	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:

---

Annual Cost to Federal Government: $1,400

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]? 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: 07/08/2016

---