Community Residential Care (CRC) Program - Recordkeeping, Incident Reporting, Applications

Forms and Documents

Document Name	Status
Form 10-387 MFH Application Form and Instruction	New
Form 10-2407 CRC Application Form and Instruction	New
30-day FRN_2900-0491_CRC Program-Recordkeeping Incident Reporting Applications_pub 12132024.pdf Supplementary Document	2024-12-13
60-day FRN_2900-0491_Community Residential Care (CRC) Program - Recordkeeping, Incident Reporting, Applications_pub 10072024.pdf Supplementary Document	2024-10-08
SSA_2900-0491_Community Residential Care (CRC) Program_updated Dec 2024.docx Supporting Statement A	2024-12-13

IC Document Collections

IC ID	Document Title	Status
271297	MFH Application Form and Instruction	New
271046	CRC Application Form and Instruction	New
271045	CRC Inident Reporting	New
148312	Community Residential Care Recordkeeping	Modified

ICR Details

OMB Control No: 2900-0491	ICR Reference No: 202409-2900-003
Status: Received in OIRA	Previous ICR Reference No: 202102-2900-019
Agency/Subagency: VA	Agency Tracking No: 2900-0491
Title: Community Residential Care (CRC) Program - Recordkeeping, Incident Reporting, Applications
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 12/13/2024

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	3,400	0
Time Burden (Hours)	4,484	0
Cost Burden (Dollars)	0	0

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Abstract: VA is authorized under 38 U.S.C. 1730 to assist veterans by referring them for placement, and aiding veterans in obtaining placement, in Community Residential Care (CRC) facilities, which include Medical Foster Homes (MFHs). One of the standards a CRC facility must meet is the requirement to maintain records on each resident in a secure place. Under 38 CFR 17.63(i), facility records must include emergency notification procedures and a copy of all signed agreements with the resident. These records must be maintained by the CRC facility, and the CRC facility must make those records available for VA inspection upon request. An MFH is a subtype of CRC and, under 38 CFR 17.74(q), is required to comply with the recordkeeping requirements of 38 CFR 17.63(i). In addition, the CRC facility must maintain and make available, upon request of the approving official, records related to CRC staff requirements and provide that the CRC facility has sufficient, qualified staff on duty and available to care for the resident and ensure the health and safety of each resident. VA is adding to this collection the requirement under 38 CFR 17.63(j)(3) that CRC facilities report alleged violations involving mistreatment, neglect, or abuse of a veteran to the approving official. VA requires the CRC facility to document and investigate evidence of an alleged violation, including misappropriation of resident property. VA views the reporting, documenting, and investigating of an alleged incident and the subsequent report of the results of the investigation to be one collection of information. VA Forms 10-2407 and 10-387 also are being included in this collection. The 10-2407 form is the CRC application used by residential care home sponsors seeking VA approval to provide care to veterans. The 10-387 form is the MFH application used by medical foster home caregivers seeking VA approval to provide care to veterans. The applicants supply references and agree to a VA inspection of the home, a monthly rate, and compliance with other VA standards for residential care. This information is collected under the authority of 38 U.S.C. 1720 and 38 U.S.C.1730.

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Authorizing Statute(s): US Code: 38 USC 1730
   US Code: 38 USC 1720
  

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:
	89 FR 81152	10/07/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 10109	12/13/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
CRC Application	10-2407	Residential Care Home Program Sponsor Application
CRC Inident Reporting
Community Residential Care Recordkeeping
MFH Application	10-387	Medical Foster Home Caregiver Application

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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	3,400	0	0	3,400	0	0
Annual Time Burden (Hours)	4,484	0	0	4,484	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: No

Burden Reduction Due to:

Short Statement: There is a burden hour increase due to the addition of incident reporting and CRC/MFH sponsor and caregiver application forms to this information collection.

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Annual Cost to Federal Government: $6,991

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.     No

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.     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? 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: 12/13/2024

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