VA-FSC Vendor File Request - Form 10091

Forms and Documents

Document Name	Status
Form VA Form 10091 FSC Vendor File Request - VA Form 10091 Form and Instruction	Modified
Form VA Form 10091 FSC Vendor File Request - VA Form 10091 Form and Instruction	Modified
OMB Memorandum_Non-substantive Chg Req_2900-0846_VA Form 10091_2023.pdf Justification for No Material/Nonsubstantive Change	2023-08-09
OMB Memorandum_Non-substantive Chg Req_2900-0846_VA Form 10091_2023.pdf Justification for No Material/Nonsubstantive Change	2023-08-09
30-day FRN_VA-FSC Vendor File Request_VA Form 10091_published_04232020.pdf Supplementary Document	2020-11-12
30-day FRN_VA-FSC Vendor File Request_VA Form 10091_published_04232020.pdf Supplementary Document	2020-11-12
60-day FRN_VA-FSC Vendor File Request_VA Form 10091_published_10072019.pdf Supplementary Document	2020-04-17
60-day FRN_VA-FSC Vendor File Request_VA Form 10091_published_10072019.pdf Supplementary Document	2020-04-17
Supporting Statement A_FSC Vendor File Request_VA Form 10091_revised 2020.docx Supporting Statement A	2020-11-12
Supporting Statement A_FSC Vendor File Request_VA Form 10091_revised 2020.docx Supporting Statement A	2020-11-12

IC Document Collections

IC ID	Document Title	Status
221305	FSC Vendor File Request - VA Form 10091 Form and Instruction	Modified
221305	FSC Vendor File Request - VA Form 10091 Form and Instruction	Modified

ICR Details

OMB Control No: 2900-0846	ICR Reference No: 202308-2900-005
Status: Active	Previous ICR Reference No: 201908-2900-008
Agency/Subagency: VA	Agency Tracking No: 2900-0846
Title: VA-FSC Vendor File Request - Form 10091
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: 08/11/2023
	Date Received in OIRA: 08/10/2023
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2024	01/31/2024	01/31/2024
Responses	150,000	0	150,000
Time Burden (Hours)	37,500	0	37,500
Cost Burden (Dollars)	0	0	0

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Abstract: The authorizing statute for this data collection falls under 31 USC 3701 and Public Law 104-134, Section 31001, Debt Collection Improvement Act of 1996. The mission of the Nationwide Vendor File Division of the Department of Veterans Affairs – Financial Services Center (VA-FSC) is to add, modify, or delete vendor records in the Financial Management Services (FMS) vendor file. The VA-FSC FMS vendor file controls aspects of when, where, and how vendors are paid. There are currently more than 2.4 million active vendor records in FMS. The VA-FSC Vendor File Request Form, VA Form 10091, was created to streamline the data required to establish a vendor record from multiple sources into a single form. VA Form 10091 will be used throughout the VA to gather essential payment data from vendors (commercial, individuals, Veterans, employees, etc.) to establish or update vendor records in order to process electronic payments through the ACH network to the vendor's financial institution.

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Authorizing Statute(s): US Code: 31 USC 3701 Name of Law: Debt Collection Improvement Act of 1996
   PL: Pub.L. 104 - 134 31001 Name of Law: Debt Collection Improvement Act of 1996
  

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 53571	10/07/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 22798	04/23/2020
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
FSC Vendor File Request - VA Form 10091	VA Form 10091, 10091, 10091, 10091	FSC Vendor File Request - VA Form 10091 ,   FSC Vendor File Request ,   FSC Vendor File Request ,   FSC Vendor File Request

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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	150,000	150,000	0	0	0	0
Annual Time Burden (Hours)	37,500	37,500	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: $173,925

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: 08/10/2023

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