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Federal forms, ICRs, and supporting documents

Information Collection Request

Army Chemical Corps Vietnam Health Study, VA Form 10-20998 (NR)

ICR 199607-2900-002 · OMB 2900-0563 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
28744 Army Chemical Corps Vietnam Health Study, VA Form 10-20998 (NR) Form Migrated
ICR Details
2900-0563 199607-2900-002
Historical Active
VA
Army Chemical Corps Vietnam Health Study, VA Form 10-20998 (NR)
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 09/13/1996
Retrieve Notice of Action (NOA) 07/09/1996
OMB approves the Phase I/Pilot of this study through 3/98 under the following conditions: 1) the VA immediately incorporates the disclosure statements mandated by the Paperwork Reduction Act of 1995. For the public record, the VA must submit to OMB the revised forms/instructions; 2) in the next submission for OMB review, the VA includes an analysis of the pilot. Such an analy- sis must include an evaluation of general and item nonresponse, nonresponse bias, and the validity of self-reported data when compared to VA medical records. In addition, the VA must design follow-up procedures and conduct this pilot with the objective of achieving an 80% response rate for Phase II; 3) the next submission for OMB review must include an assessment of the reliability and validity of paternal responses to questions on reproductive outcomes and maternal health behaviors; and 4) the next submission for OMB review must describe how the VA will compare the findings of this study to other Agent Orange research such as the CDC Vietnam Experience Study and the VA's Study of Reproductive Health Outcomes Among Women Vietnam Veterans.
  Inventory as of this Action Requested Previously Approved
03/31/1998 03/31/1998
650 0 0
325 0 0
0 0 0
This studies indications that Army Chemical Corps Vietnam Veterans and their families suffer from unusually high rates of illness and the relationship between health outcomes and possible exposure. The focus will include cancer, pregnancy outcomes, birth outcomes, childhood cancer and infertility.
None
None
No
1
IC Title Form No. Form Name
Army Chemical Corps Vietnam Health Study, VA Form 10-20998 (NR) 10-20998
  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 650 0 0 650 0 0
Annual Time Burden (Hours) 325 0 0 325 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No
$0
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected
  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.
07/09/1996