Title 38 Positions - Applications and Appraisals for Employment - VA Forms 10-2850, 10-2850a, 10-2850c, 10-341(a)

Forms and Documents

Document Name	Status
Form FL 10-341(a) Appraisal of Applicant Form and Instruction	New
Form 10-2850c Application for Associated Health Occupations Form and Instruction	New
Form 10-2850a Application for Nurses and Nurse Anesthetists Form and Instruction	New
Form 10-2850 Application for Physicians, Dentists, Podiatrists, Optometrists, and Chiropractors Form and Instruction	New
Form 10-2850D Application for Health Professions Trainees - 10-2850D Form	Modified
30-day FRN_2900-0205_Title 38 Applications & Appraisals for Employment_pub 11192020.pdf Supplementary Document	2020-11-19
60-day FRN_2900-0205_Title 38 Applications & Appraisals for Employment_pub 04152020.pdf Supplementary Document	2020-04-24
Supp Statement A_2900-0205_Title 38 Applications - VA Form 10-2850 series_revised Nov 2020.docx Supporting Statement A	2020-11-19

IC Document Collections

IC ID	Document Title	Status
241295	Appraisal of Applicant Form and Instruction	New
241294	Application for Associated Health Occupations Form and Instruction	New
241293	Application for Nurses and Nurse Anesthetists Form and Instruction	New
241292	Application for Physicians, Dentists, Podiatrists, Optometrists, and Chiropractors Form and Instruction	New
235698	Application for Health Professions Trainees - 10-2850D Form	Modified

ICR Details

OMB Control No: 2900-0205	ICR Reference No: 202001-2900-006
Status: Received in OIRA	Previous ICR Reference No: 201904-2900-002
Agency/Subagency: VA	Agency Tracking No: 2900-0205
Title: Title 38 Positions - Applications and Appraisals for Employment - VA Forms 10-2850, 10-2850a, 10-2850c, 10-341(a)
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  Yes
Type of Review Request: Regular	Date Submitted to OIRA: 11/20/2020

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2022
Responses	152,963	121,000
Time Burden (Hours)	76,482	60,500
Cost Burden (Dollars)	0	0

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Abstract: The collection of this information is authorized by Title 38, United States Code (U.S.C.) 7403, (Veterans’ Benefits), which provides that appointments of Title 38 employees will be made only after qualifications have been satisfactorily verified in accordance with regulations prescribed by the Secretary. Occupations listed in 38 U.S.C. 7401(1) and 7401(3) (Appointments in Veterans Health Administration), are appointed at a grade and step rate or an assignment based on careful evaluation of their education and experience. VA Forms 10-2850, 10-2850a and 10-2850c are applications designed specifically to elicit appropriate information about each candidate's qualifications for employment with Department of Veterans Affairs (VA) as well as educational and experience. To assure that a full evaluation of each candidate's credentials can be made prior to employment, the forms require disclosure of details about all licenses ever held, Drug Enforcement Administration certification, board certification, clinical privileges, revoked certification or registration, liability insurance history, and involvement in malpractice proceedings. VA Form Letter 10-341a is the pre-employment reference form used to elicit information concerning the prior education and/or performance of the Title 38 applicant. Information provided is used to determine eligibility for employment and the appropriate grade and step rate or assignment.

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Authorizing Statute(s): US Code: 38 USC 7401 (1),(3) Name of Law: Appointments in Veterans Health Administration
   US Code: 38 USC 7403 Name of Law: Veterans Benefits - Period of appointments; promotions
   US Code: 38 USC 7302 - Part V, Chapter 73 Name of Law: Healthcare Personnel Education and Training Program
  

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:
	85 FR 21071	04/15/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 73851	11/19/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Application for Health Professions Trainees - 10-2850D	10-2850D	Application for Health Professions Trainees
Application for Physicians, Dentists, Podiatrists, Optometrists, and Chiropractors	10-2850	Application for Physicians, Dentists, Podiatrists, Optometrists, and Chiropractors
Application for Nurses and Nurse Anesthetists	10-2850a	Application for Nurses and Nurse Anesthetists
Application for Associated Health Occupations	10-2850c	Application for Associated Health Occupations
Appraisal of Applicant	FL 10-341(a)	Appraisal of Applicant

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ICR Summary of Burden

	Total Request	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	152,963	121,000	0	31,963	0	0
Annual Time Burden (Hours)	76,482	60,500	0	15,982	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: VA increased the number of anticipated respondents for each form due to projected increases in Title 38 program applications since the last PRA clearance. Note that VA Form 10-2850D is part of the collection under 2900-0205, but OMB issued a separate NOA on October 10, 2019, due to necessary expedited review in conjunction with a new VA regulation. Therefore, the burden for VA Form 10-2850D is not included in this request for a renewal 3-year PRA clearance for the remaining forms in 2900-0205.

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Annual Cost to Federal Government: $15,172,527

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? No

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Common Form ICR:  Yes

Description/Changes for Common Form Usage: 

Approved RCFs using this ICR

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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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: 11/20/2020

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