Application for Accreditation as Service Organization Representative

Forms and Documents

Document Name	Status
Form VA21 Application for Accreditation as Service Organization Representative Form	Modified
30-Day FedRegNotice 2900-0018 Published 10-21-2019.pdf Supplementary Document	2019-10-23
60-Day FedRegNotice 2900-0018 Published 07-25-2019.pdf Supplementary Document	2019-10-23
2900-0018 Justification A Template (Rev2017) (final) (09252019).docx Supporting Statement A	2019-10-23

IC Document Collections

IC ID	Document Title	Status
28110	Application for Accreditation as Service Organization Representative Form	Modified

ICR Details

OMB Control No: 2900-0018	ICR Reference No: 201910-2900-005
Status: Active	Previous ICR Reference No: 201508-2900-002
Agency/Subagency: VA	Agency Tracking No: 2900-0018
Title: Application for Accreditation as Service Organization Representative
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/11/2020
	Date Received in OIRA: 11/21/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2023	36 Months From Approved
Responses	4,713	0	0
Time Burden (Hours)	1,013	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Application For Accreditation - representatives of service organizations use this form to apply for VA accreditation to represent claimants for benefits before VA.

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Authorizing Statute(s): 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 5902 Name of Law: Recognition of representatives of organizations
   US Code: 38 USC 5901 Name of Law: Prohibition against acting as claims agent or attorneyion
  

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:
	84 FR 35929	07/25/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 56284	10/21/2019
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
Application for Accreditation as Service Organization Representative	VA21	APPLICATION FOR ACCREDITATION AS SERVICE ORGANIZATION REPRESENTATIVE

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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	4,713	0	0	1,556	0	3,157
Annual Time Burden (Hours)	1,013	0	0	231	0	782
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: The adjustment is a program adjustment due to change in estimate number of filings.

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Annual Cost to Federal Government: $41,383

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 11/21/2019

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