OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

State Home Programs for Veterans (VA Forms 10-5588, 10-5588A, 10-10SH) -- AR61

ICR 202410-2900-027 · OMB 2900-0160 · Received in OIRA

Forms and Documents
Document
Name
Status
Form and Instruction
 Unchanged
Form and Instruction
 Unchanged
Form
 Unchanged
Supporting Statement A
2024-10-30
IC Document Collections
IC ID
Document
Title
Status
271865
Unchanged
237053 Unchanged
237052 Unchanged
237051 Unchanged
ICR Details
2900-0160 202410-2900-027
Received in OIRA 202410-2900-019
VA 2900-0160
State Home Programs for Veterans (VA Forms 10-5588, 10-5588A, 10-10SH) -- AR61
Revision of a currently approved collection   No
Regular 10/30/2024
  Requested Previously Approved
10/31/2026 10/31/2026
13,616 13,614
4,819 4,816
0 0
The information collection under OMB Control Number 2900-0160 includes VA Forms 10-5588, 10-5588A, and 10-10SH and has a current Paperwork Reduction Act (PRA) clearance with an expiration date of 10/31/2026. VHA is implementing a new regulation that will add another element to this information collection. Specifically, the new regulation will allow State homes to submit a list of veteran names to VA for reconsideration of previously denied claims. This will be a time limited opportunity that must occur within 30 days of the effective date of the rule. Authority for this information collection can be found in two public laws affecting State homes: Public Law 115-159, the State Veterans Home Adult Day Health Care Improvement Act of 2017, which requires VA to pay State Veteran Homes (SVHs) for medical model adult day health care provided to certain eligible Veterans; and Public Law 116-315, Section 3007, Waiver of Requirements of Department of Veterans Affairs for Receipt of Per Diem Payments for Domiciliary Care at State Homes and Modification of Eligibility for such Payments. This information collection also enables the payment of per diem to State homes that provide care to eligible Veterans in accordance with Title 38, CFR Part 51. The intended effect of these provisions is to create a safeguard that Veterans are receiving a high quality of care in SVHs. To ensure that high quality care is furnished to Veterans, VA requires those facilities providing nursing home care, domiciliary care, and adult day health care programs to Veterans to supply various kinds of information. The information required includes an application and justification for payment; records and reports that facility management must maintain regarding payment activities of residents or participants; and records and reports that facilities management and health care professionals must maintain regarding eligibility and level of care for residents or participants. The following three forms are included in this information collection: 10-5588, 10-5588A, and 10-10SH. The State Home Per Diem (SHPD) Program made updates to the automated the 10-10SH form to increase functionality and usage. This form was converted into a web-based, fillable form that can be electronically submitted from the SVH to the appropriate VAMC. It includes data field validation, assuring that all required fields have been filled before the user can electronically submit the 10-10SH form. The VA portion of the application also includes business rules to assist the VA representatives in making uniform determinations, allow the VA representative to return incomplete applications to the SVH along with a notification to them, and record the receipt of the completed application.
PL: Pub.L. 115 - 159 2 Name of Law: State Veterans Home Adult Day Health Care Improvement Act of 2017
   PL: Pub.L. 116 - 315 3007 Name of Law: Veterans Health Care and Benefits Improvement Act of 2020
   PL: Pub.L. 109 - 461 211(a)(5) Name of Law: Veterans Benefits, Health Care, and Information Technology - Modification to State Home Authorities
  
None
2900-AR61 Final or interim final rulemaking 89 FR 86245 10/30/2024
No
  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 13,616 13,614 0 2 0 0
Annual Time Burden (Hours) 4,819 4,816 0 3 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Changing Regulations
No
The burden hour increase is due to new authority granted by section 3007(a) of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 (Pub. L. 116-315, January 5, 2021) which allows VA to submit a List of Veteran Names for Claim Reconsideration. 38 CFR 51.42(c) provides for the resubmission of the names of Veterans whose claims were previously denied by VA, and this will add an estimated 3 burden hours to the collection.
$212,777
No
    Yes
    Yes
No
No
No
No
Frances O'Donnell 703 405-2449 fran.odonnell@cathexiscorp.com
  No
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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
10/30/2024