OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Survey of Chronic Gastrointestinal Illness in Persian Gulf Veterans (Irritable Bowel Syndrome - Diarrhea)

ICR 201209-2900-003 · OMB 2900-0742 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form VA Form 10-21092c Survey of Chronic Gastrointestinal Illness inPersian Gulf Veterans (Irritaable Bowel syndrome - Diarrhea) Form and Instruction Modified Available
Colonoscopy Consent Form.pdf Supplementary Document Uploaded 2009-09-29 Available
Justification_A_Form_10-21092a-c(V3).doc Supporting Statement A Uploaded 2013-01-14 Available
10-21092a Survey Cover Letter.doc Supplementary Document Uploaded 2009-09-28 Available
Justification B (v3)[2012].doc Supporting Statement B Uploaded 2012-10-11 Available
Gulf IBS Study IRB Approval 2009.pdf Supplementary Document Uploaded 2009-04-29 Available
Patient Introductory Letter.doc Supplementary Document Uploaded 2009-04-29 Available
Patient 2nd Response Letter.doc Supplementary Document Uploaded 2009-02-23 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
188135 Survey of Chronic Gastrointestinal Illness inPersian Gulf Veterans (Irritaable Bowel syndrome - Diarrhea) Form and Instruction Modified
ICR Details
2900-0742 201209-2900-003
Historical Active 200902-2900-012
VA 2900-0742
Survey of Chronic Gastrointestinal Illness in Persian Gulf Veterans (Irritable Bowel Syndrome - Diarrhea)
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 04/09/2013
Retrieve Notice of Action (NOA) 03/04/2013
OMB does not approve this collection. This action is taken to provide VA with an active control number that may be discontinued. VA will discontinue this control number within 1 month of issuance.
  Inventory as of this Action Requested Previously Approved
04/30/2014 12 Months From Approved
4,354 0 0
3,072 0 0
0 0 0
700,00 U.S. military troops were deployed in the first Persian Gulf War. Upon return, nearly 25% of those Veterans had persistent gastrointestinal symptoms, typical of diarrhea-predominant irritable bowl syndrome (IBS). This is suspected to be related to their military service in the Gulf. Collection of data will allow VA to measure and evaluate the burden of chronic gastrointestinal illness and the goal of which is improved healthcare for Veterans.
US Code: 38 USC Part 1, Chapter 5, Section 527 Name of Law: Veterans Benefits
  
None
Not associated with rulemaking
  77 FR 204 10/22/2012
78 FR 20 01/30/2013
No
  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 4,354 0 0 0 354 4,000
Annual Time Burden (Hours) 3,072 0 0 0 0 3,072
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$70,028
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Crystal Rennie 202 632-7492 [email protected]
  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.
03/04/2013