VBA Contractor Background Investigation Request (VA Form 20-10276), VBA Affiliate Background Investigation Request (VA Form 20-10276a)

Forms and Documents

Document Name	Status
Form 20-10276 VBA Contractor Background Investigation Request (VA Form 20-10276), VBA Affiliate Background Investigation Request (VA Form 20-10276a) Form	Modified
30-Day FRN - 2900-0915 (2024).pdf Supplementary Document	2024-12-23
60-Day FRN - 2900-0915 (2024).pdf Supplementary Document	2024-11-19
2900-0915 Supporting Statement (VA Form 10276 Series).docx Supporting Statement A	2024-12-23

IC Document Collections

IC ID	Document Title	Status
253236	VBA Contractor Background Investigation Request (VA Form 20-10276), VBA Affiliate Background Investigation Request (VA Form 20-10276a) Form	Modified

ICR Details

OMB Control No: 2900-0915	ICR Reference No: 202410-2900-006
Status: Received in OIRA	Previous ICR Reference No: 202204-2900-016
Agency/Subagency: VA	Agency Tracking No: VBA-HCS-YA
Title: VBA Contractor Background Investigation Request (VA Form 20-10276), VBA Affiliate Background Investigation Request (VA Form 20-10276a)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 12/23/2024

	Requested	Previously Approved
Expiration Date	36 Months From Approved	09/30/2025
Responses	10,000	5,000
Time Burden (Hours)	2,167	833
Cost Burden (Dollars)	0	0

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Abstract: VA Forms 20-10276 and 20-10276a are used to gather the mandatory information to determine eligibility for employment and have physical and logical access for VBA. Without this information, determination of eligibility for employment and access would not be possible. The new form (VA Form 20-10276a) added to this collection is used to collect information from Affiliates who are applying to work/volunteer for VBA. After the collection, personnel security specialists can perform background investigation work to determine eligibility for employment and to have physical and logical access to VBA Systems.

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Authorizing Statute(s): None

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 83953	10/18/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 104613	12/23/2024
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
VBA Contractor Background Investigation Request (VA Form 20-10276), VBA Affiliate Background Investigation Request (VA Form 20-10276a)	20-10276, 20-10276a	VBA Contractor Background Investigation Request ,   VBA Affiliate Background Investigation Request

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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	10,000	5,000	0	5,000	0	0
Annual Time Burden (Hours)	2,167	833	0	1,334	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: The burden has increased due to the addition of this new form.

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Annual Cost to Federal Government: $729,887

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: 12/23/2024

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