Application for Reimbursement of Licensing or Certification Test Fees (VA Form 22-0803)

Forms and Documents

Document Name	Status
Form VA Form 22-0803 Application for Reimbursement of Licensing or Certification Test Fees Form	Modified
Non-Substantive Change for 0803.docx Justification for No Material/Nonsubstantive Change	2020-07-24
2018-18918.pdf Supplementary Document	2018-10-16
SupportState(2900-0695) (2).docx Supporting Statement A	2018-06-18
2018-03586.pdf Supplementary Document	2018-02-22

IC Document Collections

IC ID	Document Title	Status
179084	Application for Reimbursement of Licensing or Certification Test Fees Form	Modified

ICR Details

OMB Control No: 2900-0695	ICR Reference No: 202007-2900-008
Status: Active	Previous ICR Reference No: 201801-2900-012
Agency/Subagency: VA	Agency Tracking No: VBA-EDU-MS
Title: Application for Reimbursement of Licensing or Certification Test Fees (VA Form 22-0803)
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: 08/07/2020
	Date Received in OIRA: 08/06/2020
Terms of Clearance: We ask that VA please examine the potential to remove collection of Social Security Numbers from this form prior to re-submission.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2022	02/28/2022	02/28/2022
Responses	2,641	0	2,641
Time Burden (Hours)	660	0	660
Cost Burden (Dollars)	0	0	0

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Abstract: Individuals who wish to receive reimbursement under the education programs VA administers for a licensing or certification test, must use VA Form 22-0803 to apply for that reimbursement.

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Authorizing Statute(s): US Code: 38 USC Section 3241 Name of Law: Requirements
   US Code: 38 USC Section 3471 Name of Law: Applications; approval
   US Code: 38 USC Section 3513 Name of Law: Application
   US Code: 38 USC Section 3689 Name of Law: Approval requirements for licensing and certification testing
   US Code: 38 USC Section 5101 Name of Law: Claims and forms
   US Code: 38 USC Section 501 Name of Law: Rules and Regulations
   US Code: 38 USC Section 3034 Name of Law: Program administration
  

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:
	83 FR 3586	02/22/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 18918	08/31/2018
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Application for Reimbursement of Licensing or Certification Test Fees	VA Form 22-0803	Application for Reimbursement of Licensing or Certification Fees

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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	2,641	2,641	0	0	0	0
Annual Time Burden (Hours)	660	660	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:

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Annual Cost to Federal Government: $24,192

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:  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: 08/06/2020

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