**October 7, 1991 MP-1, Part II**

**Chapter 4**

**CONTENTS**

**CHAPTER 4. FORMS MANAGEMENT**

PARAGRAPH PAGE

1\. Purpose and Scope 4-1

2\. Policy 4-1

3\. Responsibilities 4-1

4\. Definitions 4-3

APPENDIX A. Forms Management Guidelines and Procedures

1\. General 4A-1

2\. Information Collections From the Public, State and Local Governments
4A-4

3\. Oversight and Reporting Requirements 4A-7

End of Page 4-i

**October 7, 1991 MP-1, Part II**

**Chapter 4**

**CHAPTER 4. FORMS MANAGEMENT**

1\. **PURPOSE AND SCOPE**

a\. This chapter provides policy and responsibilities for managing forms
used within the Department of Veterans Affairs (VA). It also provides
policy for submitting VA\'s information collection budget to the Office
of Management and Budget (OMB) and clearing all public-use collections
of information through OMB.

b\. The relevant authority and requirements are: Section 4(d) of the
Department of Veterans Affairs Act, Public law No. 100-527; Title 41
CFR, Chapter 201, Federal Information Resources Management Regulations,
Part 201-9, Subpart 201-9.1, Agency Programs (formerly part 201-45,
Subpart 201-45.104, Forms Management); Paperwork Reduction Act of 1980
(PRA), as amended (44 U.S.C. Chapter 35); the Paperwork Reduction
Reauthorization Act of 1986 (PRRA); Title 5, CFR, Part 1320, Controlling
Paperwork Burdens on the Public; Title 44, U.S.C. Chapters 5 and 11,
Public Printing and Documents; Title 5, U.S.C. Section 552a, Privacy Act
of 1974; Title 38 U.S.C. Sections 5701, 5705, and 7332 (formerly
Sections 3301, 3305, and 4232), Veterans Benefits; and Executive Order
12291, Federal Regulation. Non statutory guidance is provided in OMB
Circular A-129, Managing Federal Credit Programs.

2\. **POLICY**

a\. Only information essential to the conduct or management of VA
programs will be collected. The need for and intended use of information
will be fully justified and documented prior to its collection.
Information to be collected from the public, and from State or local
governments will have prior approval of OMB before it may be collected.

b\. An approved collection of information which has been allowed to
expire or is under OMB review at the time of expiration is not
authorized or enforceable after its expiration date until approval has
been granted by OMB.

c\. The forms management program will be coordinated with other
management programs, such as reports control, records management,
equipment analysis, work simplification, work measurement, and incentive
awards. The developer of a form (or the individual in Central Office
processing a field station submission) and staff personnel responsible
for these management programs must maintain a close working
relationship.

d\. Forms will be developed that are easy to read, fill-in, process,
transmit, and retrieve. Forms will display an authorized form number.
Standardized printing, form, and style should be used to reduce
reproduction costs and improve production costs and improve
productivity.

e\. Information technology (the use of computer-generated forms and
forms created using electronic means) is encouraged in the creation,
use, and maintenance of forms to reduce and control burdens associated
with the collection of information from individuals, businesses, and
other private entities, and State and local governments, and to reduce
program operating costs to the Government.

**October 7, 1991 MP-1, Part II**

**Chapter 4**

f\. Forms will be periodically evaluated for continued effectiveness and
improvement. Unnecessary forms will be eliminated. Justification will be
required for existing forms to minimize program costs and improve
program efficiency.

3\. **RESPONSIBILITIES**

a\. **Assistant Secretary for Finance and Information Resources
Management**. Administers the Departmentwide forms management program
which includes:

\(1\) Developing and recommending to the Secretary policies and
directives concerning the forms management program in the Department of
Veterans Affairs.

\(2\) Serving as the senior official and the primary coordinator in the
implementation and accomplishment of goals under the PRA.

\(3\) Serving as the Chief Information Resources Officer of the
Department as designated by the Secretary under Section 4(d) of Public
Law No. 100-527, the Department of Veterans Affairs Act.

End of Page 4-1

b\. **Deputy Assistant Secretary for Information Resources Management.**
Recommends to the Assistant Secretary for Finance and Information
Resources Management the Departmentwide policies, plans, procedures and
directives pertaining to the forms management program which includes:

\(1\) Recommending actions and issuances to coordinate this program with
all other IRM programs.

\(2\) Assigning VA Form numbers to forms developed in Central Office

c\. **Associate Deputy Assistant Secretary for Information Resources
Policies and Oversight.** Recommends to the Deputy Assistant Secretary
for Information Resources Management, and carries out, the
Departmentwide policies, plans, procedures, ;and directives pertaining
to the forms management program which includes:

\(1\) Ensuring the submission of VA\'s Information Collection Budget to
OMB.

\(2\) Clearing and controlling all public-use collections of information
and reporting or recordkeeping requirements from the public, State and
local governments which include new or revised regulations and forms
recurring or non recurring reports, applications, surveys,
questionnaires (either written or oral), and other similar collections
of information to ensure that they meet the criteria specified in the
PRA; display a valid OMB control number; and contain the estimated
average burden hours per response together with the respondent burden
statement.

\(3\) participating in the Federal Information Locator System and OMB\'s
Reports Management System.

**October 7, 1991 MP-1, Part II**

**Chapter 4**

\(4\) Ensuring compliance with OMB Circular A-129 on information
collections for Federal financial assistance.

\(5\) Ensuring compliance with 41 CFR, Chapter 201.

\(6\) Ensuring the development and submission of VA\'s annual report on
the forms management program.

\(7\) Serving as the principal VA liaison with OMB, General Services
Administration, other Government agencies, technical organizations, and
private firms on the overall forms management program.

\(8\) Designating a VA Clearance Officer who will monitor and process
requests for OMB review under the PRA.

d\. **Administration Heads, Assistant Secretaries, and Other Key
Officials.** Establish and administer forms management programs in the
offices and field stations under their jurisdiction. This includes:

\(1\) Developing and issuing internal policies and procedures to
implement provisions and policies of this chapter. This includes
procedures for issuing any special instructions concerning reporting and
recordkeeping requirements, reporting procedures, or reviews, if needed.

\(2\) Coordinating activities relating to both public use and internal
forms management policies and procedures; clearance of information
collections; and preparation of data for the annual ICB with the Office
of Assistant Secretary for Finance and Information Resources Management.

\(3\) Ensuring that all information collection requests seeking
information from the public or State or local governments are approved
by OMB and are: inventoried; display a control number and, when
appropriate, an expiration date; display the estimated average burden
hours per response and the appropriate respondent burden statement
regarding public comment to VA and OMB; and contain the required PRA
notice describing (a) why the information is being collected; (b) how it
is to be used; and (c) whether responses to the request are voluntary,
required to obtain a benefit, or mandatory.

\(4\) Ensuring that all information collections for Federal assistance
include a statement as to the applicant\'s delinquency status on Federal
debts and include examples of debts, definitions of delinquency, and
defaults in accordance with OMB Circular A-129.

\(5\) Having authority over matters pertaining to control, determination
of essentiality, coordination, and final approval of all forms
controlled by their organizational element.

\(6\) Encouraging the use of the most economical processes for printing
and reproduction (including photocopying), stock replenishment, and
distribution; and the use of locally reproduced forms that have one-time
or limited usage.

\(7\) Evaluating their programs for economy and effectiveness.

**October 7, 1991 MP-1, Part II**

**Chapter 4**

End of Page 4-2

\(8\) Designating a key person in Central Office as Publications Control
Office (PCO) and ensuring that each field station under their
jurisdiction has a PCO who is responsible for forms management.

\(9\) Ensuring that a historical case file is maintained for each of
their controlled public use and internal forms, including information on
each form\'s purpose, use, disposition, development, clearance, and, if
appropriate, publication.

c\. **The Chief Medical Director, the Chief Benefits Director and the
Assistant Secretary for Human Resources and Administration (AS/HRA)**
will adhere to forms design and specifications guidelines outlined in
MP-1, part II, chapter 4, appendix A, for public use and internal forms
under their jurisdiction and the responsibilities outlined in paragraph
d. above. The AS/HRA is also responsible for forms design for the
Assistant Secretaries, Director, National Cemetery System and other key
officials.

4\. **DEFINITIONS**

The following terms represent approved definitions as they relate to all
information resources management:

a\. **Burden.** The total time and financial resources required to
respond to a request for collection of information, including time to
read or hear instructions; develop, modify, construct, or assemble any
materials or equipment; conduct tests, inspections, polls, observations,
or the like necessary to obtain information; organize the information
into the requested format; to review its accuracy; and maintain,
disclose, or report the information. (See 5 CFR 1320.7(b), and MP-1, pt.
II, ch. 4, app. A, pars. 2a and 2b.

b\. **Collections of Information (also referred to as Information
Collections).** The obtaining or soliciting of information, or
sponsoring of such a collection, by any element of VA from 10 or more
persons by means of identical questions, or identical reporting or
recordkeeping requirements, whether such collection of information is
mandatory, voluntary, or required to obtain a benefit. This includes
requirements or requests for persons to obtain, maintain, retain,
report, or publicly disclose information. (See 5 CFR Section 1320.7(c).)

c\. **Collections of Information Request.** The method by which VA
announces the specifications for collections of information to potential
respondents. This includes written report forms, application forms,
schedules, questionnaires, oral communications, reporting or
recordkeeping requirements, or other similar methods.

d\. **Collections of Information Requirement.** The term used for
collections of information by means of a VA rule (codified in the Code
of Federal Regulations) published and adopted in accordance with public
notice and comment on the rulemaking procedures. The term includes any
specific form or other written instrument used for collection of
information that is incorporated as part of the rule.

**October 7, 1991 MP-1, Part II**

**Chapter 4**

e\. **Electronic Form.** An electronic representation or facsimile of
forms that reside in an electronic medium in the Department\'s
computerized information systems and can be ;managed and processed
electronically.

f\. **Field Station Form.** Forms developed by one field station for use
by that station only.

g\. **Form.** A fixed arrangement of captioned spaces designed for
entering and extracting prescribed information.

h\. **Federal Register.** A daily publication that provides a uniform
system for publishing Presidential and Federal agency documents.

i\. **Information Collection Budget (ICB).** A document that identifies
the total number of burden hours for all collections of information from
the public to be conducted or sponsored by VA in the fiscal year.

j\. **Internal Form.** Standardized, electronic, and field station forms
used solely within VA.

k\. **Non recurring Form.** Forms which are printed one-time only and
used for a specific purpose for a limited period of time.

l\. **Optional Form (OF).** Forms applicable in the operations of two or
more agencies or establishments, which are approved by GSA for optional
use on a Governmentwide basis.

m\. **Person.** An individual, partnership, association, corporation
(including operations of Government-owed contractor-operated
facilities), legal representative, business trust, organized groups of
individuals, State, territory, or local government or component thereof.
Current employees of the Federal Government are excluded from this
definition for

End of Page 4-3

purposes of collections of information within the scope of their
employment. Retired and former Federal employees and veterans are
included entirely within definition. (See 5 CFR Section 1320.7(n).)

n\. **Public-Use Form.** Forms that are used to collect similar or like
information from 10 or more persons in the public or from a State or
local government.

o\. **Recordkeeping Requirement.** A requirement imposed by VA on
persons to maintain specified records. This includes requirements for
information that must be maintained or retained but not necessarily
provided to VA. (See 5 CFR Section 1320.7(p).)

p\. **Recurring Form.** Forms which may be reprinted until replaced or
discontinued.

**October 7, 1991 MP-1, Part II**

**Chapter 4**

q\. **Reporting Requirement.** A requirement imposed by VA on persons to
provide information to another person or to VA. Reporting requirements
may implicitly or explicitly include recordkeeping requirements. (See 5
CFR Section 1320.7(q).)

r\. **Respondent Burden Statement.** The Paperwork Reduction
Reauthorization Act of 1986 requires agencies to indicate on each
information collection the estimated average burden hours per response,
together with a request for public comments to VA and OMB.

s\. **Sponsor.** VA is considered to sponsor collections of information
if VA causes another agency to collect the information, contracts or
enters into a cooperative agreement with a person to collect the
information, or requires a person to provide information to another
person. VA sponsors information collections by grant recipients only
when the recipients are collecting information at the specific request
of VA or when the terms and conditions of the grant require specific
approval by VA of the collections of information or the collection
procedures. (See 5 CFR Section 1320.7(r).)

t\. **Standard Form (SF).** Forms approved by the General Services
Administration (GSA) for mandatory use by Government agencies or
establishments, unless a specific exemption is obtained.

u\. **Standardized Form.** Forms developed by Central Office for use in
Central Office and/or field stations.

v\. **Test Form.** Forms which are used for a trial period, usually for
the purpose of testing a proposed procedure at selected locations.

End of Page 4-4

**October 7, 1991 MP-1, Part II**

**Chapter 4**

**Appendix A**

**APPENDIX A. FORMS MANAGEMENT GUIDELINES AND PROCEDURES**

This appendix describes the procedures for recommending, creating,
managing, monitoring, and eliminating an information collection, or
other type of form used in the Department. Instructions for designing,
numbering, printing, and ordering a form or developing an information
collection are included, as is the process for requesting OMB review and
approval for a public use information collection.

1\. **GENERAL**

a\. Types of Information Collections and Forms

\(1\) Public use information collections include forms that collect
information from the public, and State and local governments (see MP-1,
pt. II, ch. 4, app. A, para. 2); this group represents a small
percentage of the Department\'s overall volume of forms, but each must
be approved by OMB.

\(2\) All other forms used within VA (i.e., VA standardized \-- those
developed for Central Office and field station use; field station \--
those developed for field station use only; standard and optional forms
\-- those forms common to most Federal agencies; and other Government
agency forms).

b\. **Annual Usage.** All forms having an annual usage in excess of 100
will be part of the VA Forms, Management Program. This will include
forms having information collections; internal, administrative and
operational forms; and standard, optional and other Government agency
forms.

c\. **Restrictions.** No change to the intent or content of any form may
be made without specific approval of the appropriate program office
within VA, or promulgating agency other than VA, having jurisdiction
over that form.

d\. **Approval Requirements.** The categories of forms listed below
require approval prior to use:

\(1\) Public use forms requiring approval by the Office of Management
and Budget;

\(2\) Forms originating in Central Office and VA field stations;

\(3\) Forms originating in one activity which affect functions under the
jurisdiction of another program office;

\(4\) Forms which are subject to intra-agency use; and

\(5\) Forms which are beyond the composition or reproduction capacity of
field stations, or those which must be produced by special sources, such
as carbon-interleaved or other specialty forms.

**October 7, 1991 MP-1, Part II**

**Chapter 4**

**Appendix A**

e\. **Procedures for requesting a new or revised form.** When a program
official determines that a form is needed for VA operations the
following procedures will be followed:

\(1\) Contact the appropriate Publications Control Officer (PCO) who
will assist in determining if a form exists.

\(2\) If it is determined that a form exists, and modification is
required to serve the purpose, coordination is necessary between the PCO
and the appropriate forms management staff to revise the existing form.

\(3\) If a form does not exist, the appropriate forms management staff
will assist the PCO in the application of established policies and
procedures and will help to determine essentiality, design, and
specifications for the new form.

\(4\) When a new or revised form is applicable to VA operations, the PCO
will assist the program official in preparing a VA Form 559, Request for
New or Revised Field Station Form or Form Letter (formerly VA Form
70-559, Request for New or Revised Field Station Form or Form Letter),
or VA Form 559a, Request for New or Revised Form or Form Letter (for
Central Office use) (formerly VA Form 70-559a, Request for New or
Revised Form or Form Letter (for Central Office use)). A draft copy of
the proposed form will accompany this request. Requests will be routed
to the appropriate forms management staff to avoid duplication of
procurement and stocking, and to ensure that there is a central
reference point for information concerning use of the form.

f\. **Clearance Procedures for Exception.** When a standard, optional,
or other Government agency form does not serve VA\'s purpose, the PCO
assists the program official in completing SF 152, Request for Clearance
or Cancellation of a Standard

End of Page 4A-1

or Optional Form or Exception. The PCO submits the SF 152 through the
appropriate forms management staff to Records Management Service.
Records Management Service will then seek an exception from the General
Services Administration (GSA) and will advise the PCO of GSA\'s action
taken on the SF 152.

g\. **Initial Distribution**. The initial distribution will be made of
all new forms and superseding revisions. The PCO will assist the program
official in completing VA Form 7225, Distribution Instructions for
Printed Matter formerly VA Form 3-7225, Distribution Instructions for
Printed Matter). The PCO will forward the VA Form 7225 to the
appropriate forms management staff. Each user will be furnished, as a
minimum, a sufficient number of forms for the first three months of use.

h\. **Local Reproduction.** Local reproduction is authorized for forms
that have one-time or limited usage. The following statement must appear
at the bottom of the form: \"AUTHORIZED FOR LOCAL REPRODUCTION.\" These
forms will be distributed as follows: (a) Standardized

**October 7, 1991 MP-1, Part II**

**Chapter 4**

**Appendix A**

forms through the electronic mail system or equivalent; and (b) other
Government agency forms through the Forms and Publication Depot along
with the accompanying directive.

i\. **Overprinting.** It must be determined that the savings will more
than offset the cost for overprinting repetitive fill-in data.

j\. **Replenishment of Stock**

\(1\) The Forms and Publications Depot initiates a VA Form 7700c, Stock
Replenishment Request (formerly VA Form 3-7700c, Stock Replenishment
Request), for all forms stocked in the depot and forwards the request
through the appropriate forms management staff to the PCO for
coordination and action with the program office.

\(2\) The program office initiates a VA Form 7700, Request for
Reproduction Services (formerly VA Form 3-7700, Request for Reproduction
Services), for forms stocked within the respective service or field
station ad forwards the form to Publications Service for appropriate
action.

k\. **Discontinuances.** Program officials will promptly report
obsolete, test, non recurring and nonessential forms to the appropriate
PCO. The PCO will report such forms to the appropriate forms management
staff who will notify the Forms and Publications Depot. Forms replaced
for superseded by new or revised forms will be reported on VA Form 2105
or VA Forms 559 or 559a.

l\. **Accounting Requirements**

\(1\) The PCO will assist the program office in completing SF 335,
Summary Worksheet for Estimating Form Costs, for all public-use and
interagency report forms. Instructions for completing SF 335 are on the
reverse of the form.

\(2\) The appropriate forms management staff maintains the official
history file for the form and retains the SF 335.

m\. **Catalog and Bulletin.** A combined catalog of internal and public
use forms (VA Catalog 1, Standardized Forms and Form Letters LOG 1) for
all organizational elements is compiled and issued by Publications
Service. This catalog is updated from the information provided by the
forms management staffs on a regular basis. This information is
published in periodic forms bulletins and consolidated annually in the
catalog.

n\. **Form Design and Specifications**

The following design standards apply to non-impact printed forms;
electronically printed forms, and forms produced via automatic data
processing (ADP) system.

\(1\) All forms requiring name, address and other identifying
information will follow this standard order: Last name, first name,
middle initial; number and street or post office box; city,

**October 7, 1991 MP-1, Part II**

**Chapter 4**

**Appendix A**

State, and ZIP code; Social Security number, military identification
number, or any other identification.

\(2\) Box design will be used to ensure the best use of space and ease
of data entry.

\(3\) Captions will be arranged in a logical sequence to assure ease and
accuracy of entries to and transcription of information from a form.

\(4\) \"Check Boxes\" will be used to the maximum extent possible.

\(5\) Typewriter or other machine spacing will be the controlling factor
in determining horizontal and vertical spacing of all entries.

End of Page 4A-2

\(6\) Each form will have a distinguishing title which is a concise
description of its function. The title will be located at the top of the
form unless filing or other equipment requirements dictate otherwise.

\(7\) A VA signature band, consisting of the logo and the words
\"Department of Veterans Affairs\" will be placed on each form as
prescribed by M-03-1, VA Graphics Standards Manual. Exceptions to this
provision are permitted on terms too small to accommodate the band;
where use of the band would require continuation of form to the reverse
side or additional page; where use of the identifier is deemed
inappropriate in the overall design; or where use of electronic printing
systems will not allow a satisfactory image to be obtained.

\(8\) Forms will conform to paper sizes determined by standard sheet
sizes, or by fixed requirements such as capabilities processing machines
or the size of filing equipment.

\(a\) Forms will be printed using the smallest practicable standard size
paper necessary to collect the information and to allow space for
margins; also, the minimum weight and the most economical grade of paper
will be used.

\(b\) White paper and black ink will be used. Exceptions for carbonless
or colored paper or colored inks must be justified.

\(c\) Forms which will be filed using fastener folders or other types of
loose-leaf binders will be punched for the predominant filing method at
the time of printing.

\(9\) Instructions for completing an internal VA form which exceed a
quarter of a page will not be printed on the forms. Such instructions
will appear in the corresponding Department directive. Instructions for
public use forms exceeding a quarter of a page will be printed on a
separate page.

\(10\) Public use forms will contain the following respondent burden
statement:

**October 7, 1991 MP-1, Part II**

**Chapter 4**

**Appendix A**

\"RESPONDENT BURDEN: public reporting burden for this collection of
information is estimated to average \-- minutes per response, including
the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing
the collection of information. Send comments regarding this burden
estimate or any other aspects of this collection, including suggestions
for reducing this burden to VA Clearance Office (723), 810 Vermont Ave.,
NW, Washington, DC 20420; and to the Office of Management and Budget,
Paperwork Reduction Project (2900- ), Washington, DC 20503. DO NOT send
for benefits to these addresses.\"

Any modifications to the respondent burden statement must be approved by
the VA Clearance Officer in conjunction with the OMB Desk Officer.

\(11\) When applicable, forms will contain a Privacy Act statement
meeting the requirements of the Privacy Act of 1974, 5 U.S.C. Section
552a(e)(3). Where possible, this statement will appear as the first
paragraph on non-public use forms, or the second paragraph when the OMB
respondent burden statement appears on public use forms. This Privacy
Act statement shall advise persons completing the form whether
disclosure is voluntary or mandatory; by what statutory or legal
authority such information is solicited; of the principal purpose(s0 for
which the information is intended to be used, what kinds of \"routine
use\" disclosures may be made of the information; and the effects on an
individual, if any, of not providing all or any part of the requested
information. (See 5 U.S.C. Sections 522a(e)(3) and (e)(4)(D).)

\(12\) Certification of Non-Delinquency by Applicants for Federal
Assistance (OMB Circular A-129)

\(a\) VA application forms and other VA information collections that
substantiate the awarding of financial assistance (including grants and
contracts) must include a certification that the applicant is not
delinquent on loans or other accounts to the Federal Government. A
notice of the penalties for falsification of this information must be
included with the certification.

\(b\) The following language will be used for a delinquency notice:

\"Are you presently delinquent or in default on any debt to the Federal
Government (e.g., U.S. Guaranteed Student Loan, GI Bill Education
Benefits, home or manufactured home mortgage or improvement loan, SBA
loan, Public Health Service loan, bond, loan guarantee)? ( ) YES ( ) NO.
If \"Yes,\" give details, including date, name and address of lender,
case or file numbers, and reasons for action.\"

\(13\) Use of specialty forms (carbon-interleaved, marginally punched,
continuous, special construction, and forms processed on electronic
printing systems) will be limited to high-volume applications where the
added cost is clearly justified in terms

End of Page 4A-3

**October 7, 1991 MP-1, Part II**

**Chapter 4**

**Appendix A**

of direct savings to VA. The minimum quantities for each type of
specialty form which can be economically procured will be a first
consideration in determining if the use of such a form is justified.

\(14\) Form letters will be developed in accordance with the guidelines
and specifications for the preparation of letters and letterhead
stationery found in H-70-1, VA Correspondence Handbook 1991.

o\. **Numbering System.** The following are guidelines for standard
identification of forms:

\(1\) In order to enhance the management and use of VA standardized
forms, numerical prefixes will appear only on standardized forms
controlled by the Administrations and National Cemetery System.
Numerical prefixes will be deleted from all other VA standardized forms
as depot stocks are replenished or when forms are revised, whichever
comes first. New general administrative forms will no longer carry
numerical prefixes.

\(2\) Field station form numbers will be assigned by local PCOs, and
will include the station number in parentheses following the basic
number (e.g., VA Form 10-14(528)).

\(3\) Form numbers will appear at the lower left margin of the document
unless a design for specialized equipment, length of text, or filing
considerations require the numbers to appear at the right margin.

\(4\) Numbers on closely related forms will be assigned an alphabetical
suffix (e.g. VA Form 26-6416 and VA Form 26-641a).

\(5\) A form composed of two or more identical pages, such as 2- and
4-part carbon-interleaved sets will be assigned a numerical suffix
(e.g., VA Form 4564-2 and VA Form 4564-4).

\(6\) The following numerical prefixes will be used to identify VA
forms:

**New Prefix Old Prefix Program Responsibility**

None None, 0, 00, 1, General Administrative (forms provided for use by

2, 3, 4, 5, 06, organizational elements, where no primary

08, 9, 11, 30, jurisdiction is evident). This also includes all VA

50, 60, 70, 80, elements except Veterans Health Administration,

and 90 Veterans Benefits Administration, and National

Cemetery System.

10 10 Veterans Health Administration

20 - 29 9, 20 through 29 Veterans Benefits Administration

40 40 National Cemetery System

**October 7, 1991 MP-1, Part II**

**Chapter 4**

**Appendix A**

\(7\) Form issue dates will be designated by the first three letters of
the month in which the form is printed, and will appear in all capital
letters without punctuation (e.g., MAR 1991). The issue date will be
changed to reflect each successive revision in content or design.

\(8\) The symbol \"R\" in parentheses following the issue date (e.g.,
OCT 1991(R)), will be used to indicate that the previous edition of a
form will not be reprinted but that existing stocks will be used until
exhausted.

\(9\) The symbol \"RS\" in parentheses following the issue date (e.g.,
MAY 1991(RS)), will be used to indicate that the previous edition of a
form will no longer be used and that existing stocks will be salvaged in
accordance with current instructions.

2\. **INFORMATION COLLECTIONS FROM THE PUBLIC, STATE AND LOCAL
GOVERNMENTS**

a\. OMB review and approval is required whenever a VA element wishes to
obtain or solicit information from 10 or more members of the general
public, or State and local governments by means of identical questions.
Approval is required, whether such collection of information is
mandatory, voluntary, or required to obtain a benefit, when VA requests
the information or

End of Page 4A-4

requests another person to obtain, maintain, retain, report, or publicly
disclose the information. OMB approval must be requested in advance of
the collection.

\(1\) A collection of information includes written report forms,
application forms, schedules, questionnaires, and reporting or record
keeping requirements. Other methods of collecting information may
include contracts, agreements, policy statements, plans, rules or
regulations, planning requirements, circulars, directives, instructions,
bulletins, requests for proposal or other procurement requirements,
interview guides, disclosure requirements, labeling requirements,
telegraphic or telephonic requests, and standard questionnaires used to
monitor compliance with VA requirements.

\(2\) A VA requirement to obtain or compile information for the purpose
of disclosing such information to the public through posting,
notification, labeling, or similar disclosure requirements, constitutes
a collection of information, whenever the same requirements to obtain or
compile information would be a collection of information if the
information were provided directly to Va. The public disclosure of
information originally supplied by the Federal Government to the
recipient for the purpose of disclosure to the public is not included in
this definition.

\(3\) Questions posed to agencies, instrumentalities, or employees of
the United States are deemed collections of information if the results
are to be used for general statistical purposes.

**b. Information Collections Subject to Paperwork Reduction Act of
1980**

**October 7, 1991 MP-1, Part II**

**Chapter 4**

**Appendix A**

\(1\) **General**

When a program office wishes to initiate a collection of information,
the program office shall prepare and coordinate the SF 83, Request for
OMB Review, as outlined in the SF 83a, Instructions for Standard Form
83, and the supporting statement (see MP-1, pt. II, ch. 4, app. A, pars.
2b(3) through 2b(7), below).

\(2\) **Length of Approval.** OMB approval for new collections may not
exceed two years. Approvals for revisions, extensions, reinstatements,
and existing collections in use without a currently valid OMB control
number, may not exceed three years. Emergency and/or expedited approvals
may be granted for a period not to exceed 90 days.

\(3\) **Personal Identifier.** When an information collection includes a
personal identifier (such as name, address, Social Security number, or
other personal information) which will be used as the key to retrieving
information about that individual in a file the collection and
maintenance of that information is subject to the provisions of the
Privacy Act of 1974. Other VA confidentiality statutes may also apply.
(See MP-1, pt. II, ch. 21 and app. A.) If the information is to be filed
by such a personal identifier, and there is no established Privacy Act
system of records covering the personal information being collected, a
system of records must be established and a copy of the Federal Register
notice announcing the proposed system of records must be attached to the
supporting statement. This requirement must also be considered when VA
imposes a record keeping requirement on a person to maintain such
individual-specific records or a reporting requirement to provide such
information to another person or to VA.

\(4\) **SF 83a, Instructions for SF 83.** The SF 83A outlines the
information which must be included on the SF 83 and in the supporting
statement. Attach a copy of the form, schedule or questionnaire,
instruction, or other documents for which approval is requested, and a
copy of the appropriate section of each statute, regulation, or other
document that establishes a record keeping, reporting, or disclosure
requirement, which authorizes the collection of information.

\(5\) **Privacy Act Certification Statement.** When appropriate, the
supporting statement must contain a certification that information will
be collected, maintained, and safeguarded in accordance with the
provisions of the Privacy Act of 1974. Amendments to the Privacy Act
System(s) of Records Notice(s) must be identified. The following sample
statement may be adapted when responding to Section A. Justification,
question 10 of the SF 83.

\"VA complies with the provisions of 38 U.S.C. 3301 (now Section 5701)
and the Privacy Act of 1974 (5 U.S.C. 552a). Assurances of
confidentiality are provided in the system of records identified as
\'Loan Guaranty Home, Condominium and Manufactured Home Loan Applicant
Records, Specially Adapted Housing Applicant Records, and Vendee Loan
Applicant Records - VA\' (55VA26) as contained in the Privacy Act
Issuances, 1985 Compilation, page 785 and as amended in the Federal
Register at 51 FR24781 (7/8/86); 51FR24782 (7/8/86); 51FR28289 (8/6/86);
and 52FR721 (1/8/87).\"

End of Page 4A-5

**October 7, 1991 MP-1, Part II**

**Chapter 4**

**Appendix A**

\(6\) **Emergency or Expedited Request.** An emergency or expedited OMB
request must include the following justification in addition to the
requirements outlined in MP-1, part II, chapter 4, appendix A,
paragraphs a(1) through (5) above:

\(a\) A statement that the collection of information is essential to
VA\'s mission, that public harm will result if normal clearance
procedures are followed. \"An unanticipated event has occurred which
will prevent or disrupt the collection of information or cause a
statutory or judicial deadline to be missed if normal procedures are
followed,\" may also be used.

\(b\) The time period within which OMB should approve or disapprove the
collection of information; and

\(c\) A statement that VA has taken all practicable steps to consult
with interested agencies and members of the public in order to minimize
the burden imposed by the collection of information.

\(7\) **Preparation of SF 83**

A separate SF 83 must be prepared on requests for review of a regulation
under Executive Order (E.O.) 12291, Federal Regulation, and requests for
approval of an information collection under the PRA and 5 CFR 1320.

\(a\) A request for review and approval of a regulation under E.O. 12291
requires completion of Parts I and II, SF 83, and must be signed by the
General Counsel or designee.

\(b\) A request for review and approval of a collection of information
under the PRA requires completion of Parts I and III, SF 83.

\(c\) The SF 83 will be signed by the appropriate administration head,
Assistant Secretary, independent staff office director or designee. An
original and four copies of the SF 83, the supporting statement, and
other documents will be submitted to the Office of the Assistant
Secretary for Finance and Information Resources Management, Attention:
VA Clearance Officer.

\(8\) **Review by VA Clearance Officer**

\(a\) The VA Clearance Officer will prepare the notice to be published
in the Federal Register for all proposed collections of information,
except for those included in proposed rules published for public notice
and comment.

[1]{.underline}. The notice will be forwarded to the Federal Register
with a statement that OMB approval has been requested for the collection
of information. The notice will direct requests for information,
including requests for copies of the proposed information collection
request and supporting documentation, to the VA Clearance Officer. It
will also state that public comments concerning the collection should be
sent to the Office of Information and Regulatory Affairs, OMB,
Attention: Desk Officer for VA.

**October 7, 1991 MP-1, Part II**

**Chapter 4**

**Appendix A**

[2]{.underline}. When a proposed regulation contains an information
collection requirement, the preamble will include a statement that the
proposed collection of information requirements contained in the rule
have been submitted to OMB for review. (For additional information see
MP-1, pt. II, ch. 14, app. A.) The statement will direct that comments
concerning the collection should be sent to the Office of Information
and Regulatory Affairs, OMB, Attention: Desk Officer for VA.

\(b\) The VA Clearance Office rewards the SF 83 and supporting statement
to OMB for review and clearance. The VA Clearance Officer notifies the
requester of OMB\'s decision, and furnishes a copy of the notice.

c\. **Information Collections Not Subject To Paperwork Reduction Act of
1980**

OMB review is not required whenever a VA element wishes to obtain or
solicit information from nine or fewer members of the general public, or
State and local governments by means of identical questions. However, VA
shall ensure that collections of information required by law or
necessary to obtain a benefit, and which are submitted to nine or fewer
persons, inform potential respondents that the collection of information
is not subject to OMB review under the Act.

\(1\) PRA clearance is not required for collections of information
during:

\(a\) Conduct of a federal criminal investigation or prosecution;

\(b\) Disposition of a particular criminal matter;

\(c\) Conduct of civil action to which the United States or any official
or agency thereof is a party; or

\(d\) Conduct of an administrative action or investigation involving an
agency against specific individuals or entities.

End of Page 4A-6

\(2\) The following items are generally not subject to PRA clearance;
however, OMB may designate that any specific item constitutes a
collection of information.

\(a\) Affidavits, oaths, affirmations, certifications, receipts, changes
of address, consents, or acknowledgments, provided no burden other than
that necessary to identify the respondent (e.g., name, date, and
address).

\(b\) Samples of products or physical objects.

\(c\) Facts or opinions obtained through direct observation by an
employee or agent of VA or through non standardized oral communication
in connection with such direct observation.

**October 7, 1991 MP-1, Part II**

**Chapter 4**

**Appendix A**

\(d\) Facts or opinions submitted in response to general solicitations
of comments from the public, published in the Federal Register or other
publication, provided that no person is required to supply specific
information other than that necessary for self-identification as a
condition to VA\'s full consideration of the comment.

\(e\) Facts or opinions obtained initially or in a follow-up request
from individuals (including individuals in control groups) under
treatment or clinical examination in connection with research on,
prophylaxis to prevent a clinical disorder; direct treatment of the
disorder; or the interpretation of biological analyses of body fluids,
tissues, or other specimens; or the identification or classification of
such specimens.

\(f\) A request for facts or opinions addressed to a single person.

\(g\) Examinations designed to test the aptitude, abilities, or
knowledge of the persons tested and the collection of information for
identification or classification in connection with such examinations.

\(h\) Facts or opinions obtained or solicited in connection with public
hearings or meetings.

\(i\) Facts or opinions obtained or solicited to clarify responses to
non standardized follow-up questions relating to approved collections of
information.

3\. **OVERSIGHT AND REPORTING REQUIREMENTS**

The Office of the Assistant Secretary for Finance and Information
Resources Management will conduct periodic reviews of the forms
management program to determine the adequacy of the system and its
effectiveness in meeting the Department\'s needs. Appraisals or reviews
involving program offices will be coordinated with the appropriate
administration head, Assistant Secretary, or other key official.

a\. **Annual Report on the Forms Management Program**

\(1\) The Office of the Assistant Secretary for Finance and Information
Resources Management is required to provide consolidated statistical
data on the forms management program to the Secretary. In support of
this requirement, the Chief Medical Director, the Chief Benefits
Director, and the Deputy Assistant Secretary for Administration must
provide annual reports on their forms management programs to the Office
of the Assistant Secretary for Finance and Information Resources
Management, Attention: Associate Deputy Assistant Secretary for
Information Resources Policies and Oversight (ADAS/IRP&O). Reports
Control Symbol (RCS) 70-0406 is assigned to this report. Reports for the
year ending September 30 of each year should reach the ADAS/IRP&O no
later than the 10th workday of October. The Department report will be
compiled by October 31 of each year.

\(2\) The report will separately identify VA standardized and field
station forms (not including form and pattern letters, tags, labels,
contract clauses, instruction sheets, notices, placards, handbooks, and
posters), and will provide information on: (a) The total number of forms
in use at the

**October 7, 1991 MP-1, Part II**

**Chapter 4**

**Appendix A**

beginning of the fiscal year; (b) the number of forms eliminated; (c)
the number of forms revised; (d) the number of new forms developed; and
(e) the total number of forms in use at the end of the fiscal year. A
statement explaining any increase greater than 2 percent in the combined
total of forms in use is required.

b\. **The Information Collection Budget (ICB)**

\(1\) The Office of the Assistant Secretary for Finance and Information
Resources management compiles VA\'s ICB. The budget is prepared annually
and submitted to OMB.

\(2\) Based upon OMB\'s review of the ICB, OMB assigns a total burden
hour ceiling to VA which represents the total burden hours VA may impose
on the public during the fiscal year.

End of Page 4A-7

**December 9, 1987 DVB Supplement**

**MP-1, Part II**

**Change 29**

**CHAPTER 4. FORM, FORM LETTER AND PATTERN LIBRARY CONTROL**

SECTION A. POLICY AND PROCEDURES

PARAGRAPH PAGE

1\. Purpose 4-1

2\. Responsibility 4-1

3\. Numbering System 4-1

4\. Approval of Field Station Forms and Form Letters 4-1

5\. Production of DVB Standardized Form Letters on the Wang Word

Processing System 4-2

6\. Central Office Requests for New or Revised VA Standardized

Forms and Form Letters 4-2

7\. Recommendations by Field Stations for Creation or Revision of

VA Standardized Forms and Form Letters 4-2

8\. Overprinting at Field Stations \` 4-3

9\. Field Station Form and Form Letter Report 4-3

SECTION B. PATTERN LIBRARY CONTROL

1\. Purpose 4-5

2\. General 4-5

3\. Definitions 4-5

4\. Responsibilities\--Field Stations 4-5

End of Page 4-i

**December 9, 1987 DVB Supplement**

**MP-1, Part II**

**Change 29**

**CHAPTERS 4. FORM, FORM LETTER AND PATTERN LIBRARY CONTROL**

**SECTION A. POLICY AND PROCEDURES**

**1. PURPOSE**

The purpose of this chapter is to set forth departmental policy and
procedures concerning the standardization and control of DVB forms and
form letters, supplementary to the provisions of VA Manual MP-1, part
II, chapter 4.

**2. RESPONSIBILITY**

a\. Department-wide control and liaison with other departments and top
staff offices will be maintained by the Department PCO (Publications
Control Officer). All proposed forms and form letters originating in
Central Office DVB Service/Staff Offices will be subject to review for
determination of essentiality, design, specifications, coordination, and
final approval by the Department PCO. History files of standardized
forms and form letters will be maintained by DVB Central Office (203C2).
The control for field station forms and form letters will be maintained
by the Station PCO.

b\. Each CO DVB Service/Staff Office will designate a PCO liaison to be
responsible for review, control and approval of forms and form letters.
The designated official will, in addition to other duties, act as
liaison officer on all matters affecting form and form letters activity
in the respective service.

c\. Directors of field stations will exercise, review and control
authority through the designated Station PCO who will act as the
representative on all matters pertaining to form and form letter
activity (including the review, control and approval) of local forms and
form letters. The Station PCO will maintain files of local forms and
form letters.

d\. The Station PCO will be responsible for the review of all proposed
field station forms and form letters to determine essentiality, design,
specifications, coordination, and final approval. The history files for
local items will be maintained at the DVB field station. The file will
include: (1) signed original request for the form or form letter (VA
Form 70-559, Request for Field Station Form or Form Letter); (2) a copy
of the proposed form or form letter; (3) printed copies of each edition
of the form or form letter.

e\. It will be the joint responsibility of all three levels of the
program to effect continued review toward improvement of design and
content of existing forms and form letters, improvement of operations
through standardization of appropriate new forms or form letters, and
effecting economies in administrative control and reproduction costs.
Central Office DVB Service/Staff elements will report discontinuances of
forms and form letters to the Department PCO (203C2).

**3. NUMBERING SYSTEM**

**December 9, 1987 DVB Supplement**

**MP-1, Part II**

**Change 29**

a\. VA standardized DVB forms and form letters will be numbered by the
Department PCO. A numerical prefix to designate the responsible activity
will be as follows:

20 - Used by two or more elements of DVB

21 - Compensation and Pension Service (Adjudication)

22 - Vocational Rehabilitation and Education Service (use this prefix
for Education forms and form letters only)

23 - Administrative Service

24 - Finance (Field Stations Only)

25 - Personnel (Field Stations Only)

26 - Loan Guaranty Service

27 - Veterans Assistance Service

28 - Vocational Rehabilitation and Education Service (use this prefix
for Vocational Rehabilitation and Counseling forms and form letters
only)

District Counsel field station forms and form letters will use an 02
designation. Forms and form letters will not be revised solely to change
the numerical prefix.

b\. Field station forms and form letters will be numbered locally in
accordance with the basic system shown for VA standardized DVB forms and
form letters, with the addition of the field station number in
parenthesis following the basic form or form letter number.

**4. APPROVAL OF FIELD STATION FORMS AND FORM LETTERS**

a\. All proposed new or revised field station forms and form letters
will be submitted to the Station PCO for approval on VA Form 70-559,
along with a copy of the proposed form or form letter. All items on VA
Form 70-559 will be completed except for Items 2 and 22 through 28,
since the form no longer is submitted to Central Office. The VA Form
70-559 should include all the needed information before being sent to
the Station PCO. The PCO will review VA Form 70-559 and a copy of the
proposed form or form let

End of Page 4-1

ter. The VA Form 70-559 should be signed in Item 21 by the Station PCO
if approval is given for printing the form or form letter. A copy of the
signed VA Form 70-559, a copy of the proposed form or form letter, and a
printed copy of the form or form letter will be placed in the station
history file. Field station PCO\'s will:

\(1\) Determine whether or not there is any local or standardized form
or form letter in existence that would serve the requester\'s needs.

\(2\) Determine the need or propriety for the proposed form or form
letter (or revision).

**December 9, 1987 DVB Supplement**

**MP-1, Part II**

**Change 29**

\(3\) Determine whether or not there is an associated item in the RCS
(Records Control Schedule) VB-1, to assure proper protection and
disposition. (See MP-1, pt. II, ch. 1 for forms with no associated
item.)

\(4\) Approve the request at the station level, if the Station PCO
determines that there is a need for the new item or revision to an
existing item and

\(5\) Proceed with printing the form or form letter.

NOTE: Any proposed Field Station form or form letter that is used to
collect information or answers to identical questions or items from ten
or more persons requires OMB (Office of Management and Budget) approval
and will not be approved at the local level. These items must be
submitted to the Central Office DVB PCO for review and approval.

b\. Upon approval by the Station PCO, two printed copies of the new or
revised form or form letter will be forwarded to Central Office.
Transmittal will be on VA Form 3230 or OF 41 referring the items to
\"ATTN: DVB PCO (203C2).\" The DVB PCO will forward one copy to the
controlling service for the form or form letter (e.g., 26 for Loan
Guaranty Service) for review. The other copy will be reviewed by the DVB
forms staff. After review, if it is determined that the form or form
letter should not be an approved item, the Station PCO will be notified
to discontinue its use. (This should be the exception, since items have
already been determined to be necessary if approved at the Station
level.)

c\. Employee suggestions involving creation or revision of VA
standardized forms and form letters will be directed through proper
channels to Central Office (203C2) for evaluation. This includes
suggestions involving use of a local item DVB-wide.

5\. PRODUCTION OF DVB STANDARDIZED FORM LETTERS ON THE WANG WORD
PROCESSING SYSTEM.

a\. Field Stations are authorized to use the Wang Word Processing System
to produce DVB Standardized form letters. Central Office will continue
to maintain control over the content of these form letters. Central
Office will also print and distribute reproducible copies (contact
prints) to the field stations whenever there is a new item or revision
of an existing form letter. The field station will have the option of
using local reproduction equipment to make copies of the letter or
placing the letter on the Wang Word Processing System.

b\. Production of standardized form letters that require insertion of
additional information or contain optional paragraphs with check box
selection entries may continue in existing format. Examples of these
letters are the FL 21-96 and FL 26-207. However, if the decision is made
to use the Wang Word Processing System for production of these items, a
separate letter should be developed by extracting pertinent paragraphs
from the existing letter. These items will be added to the local pattern
letter library. The Station PCO will determine which procedure will be
followed for these letters. The letters will be provided by CO as
reproducible copies as described in paragraph 5a.

**December 9, 1987 DVB Supplement**

**MP-1, Part II**

**Change 29**

c\. There are some form letters which should not be placed on the Wang
System, specifically when the format does not lend itself to 8 1/2\" x
11\" paper; e.g., post cards, continuous form letters (FL 20-680b).
OMB-approved form letters will not be placed on the Wang Word Processing
System to ensure the content of these form letters is not altered.

d\. DVB Standardized form letters placed on the Wang System must show
the form letter number and date; ;e.g., FL 26-645, May 1987 (RS), at the
lower right of the page. Those letters that now have the Notice of
Procedural and Appellate Rights printed on the reverse must now have
these as an attachment. This notice can be a separate page of the letter
or VA Form 1-4107, Notice of Procedural and Appellate Rights, may be
attached.

e\. Upon revision or reprint of a form letter, the station will receive
reproducible copies of the letter. It will be the responsibility of the
Station PCO to see that the changes are made to the letter if it is
being produced on the Wang System.

f\. A review of Wang standardized form letters will be made a part of
Central Office station reviews.

**6. CENTRAL OFFICE REQUESTS FOR NEW OR REVISED VA STANDARDIZED FORMS
AND FORM LETTERS**

a\. For Central Office elements, the procedure for requesting new or
revised VA Standardized forms and form letters is in MP-1, part II,
chapter 4, paragraph 10.

End of Page 4-2

b\. All requests for forms and form letters that have extra cost
features must have complete justification. Examples of extra cost
features requiring justification are specialty type paper such as NCR
(no carbon required), colored ink, colored ink, colored paper,
carbon-interleaved sets.

**7. RECOMMENDATIONS BY FIELD STATIONS FOR CREATION OR REVISION OF VA
STANDARDIZED FORMS AND FORM LETTERS**

a\. Field Stations may recommend through their PCOs the creation or
revision of VA Standardized forms or form letters (for items based on
employee suggestions, see sub-par. b below). Two copies of the proposed
new or revised form or form letter accompanied by letter of
justification (no VA Form 70-559 required) will be forwarded to the DVB
PCO (203C2).

b\. Employee suggestions involving creation or revision of VA
Standardized forms or form letters will be directed through proper
channels to Central Office for evaluation. This includes suggestions
involving use of a local item VA wide (as in subpar. a above, no VA Form
70-599 is required).

**8. OVERPRINTING AT FIELD STATIONS**

**December 9, 1987 DVB Supplement**

**MP-1, Part II**

**Change 29**

a\. The overprinting of VA Forms or form letters and standard forms,
optional forms, or other Government forms with \"repetitive fill-in
data\" will be submitted to the Station PCO for approval. NOTE: When
overprinting Standard forms always use latest edition even though the
supersession notice may state previous editions may be used. Central
Office approval is not required and identification as a local form or
form letter is not required on this item.

b\. Overprinting which changes the intent or content of any standardized
form or form letter will be submitted to Central Office for approval
prior to use in the manner indicated in MP-1, part II, chapter 4,
paragraph 15b(1)(2).

c\. Forms and form letters with OMB (Office of Management and Budget)
approval (identified by the OMB approval number printed in the upper
right corner) will not be overprinted with any information except the
station name and address. Overprint of any other information is
prohibited. OMB approval must be secured by Central Office program
officials prior to addition or change of any item on a public-use
information collection document.

**9. FIELD STATION FORM AND FORM LETTER REPORT**

a\. VA Form 23-6501, Field Station Form and Form Letter Report, will be
prepared and submitted in original only. Forms and form letters
pertaining to activities under the jurisdiction of the Department of
Veterans Benefits will be included in this report. District Counsel
local forms and form letters will also be included as a separate
category.

b\. The report will review the activity during the report period and
will show the number of forms and form letters approved for use and
discontinued.

c\. The report will include a listing on VA Form 23-6501, of all forms
and form letters currently active. The date of the edition in use will
be shown.

d\. This is an annual report prepared as of the last day of December and
no subsequent actions will be reported after that date. Forward the
report to reach Central Office no later than the 20th workday of January
to:

Department of Veterans Benefits (203C2)

Veterans Administration Central Office

Washington, DC 20420

e\. RCS 20-0285 is assigned to this report.

End of Page 4-3

**December 9, 1987 DVB Supplement**

**MP-1, Part II**

**Change 29**

**CHAPTER 4. FORM, FORM LETTER AND PATTERN LIBRARY CONTROL**

**SECTION B. PATTERN LIBRARY CONTROL**

**1. PURPOSE**

A pattern library has been developed and placed on DVB Wang Systems
nationwide. This section sets forth departmental policy and procedures
concerning the standardization and control of documents in the pattern
libraries.

**2. GENERAL**

a\. The objective of the pattern library is to provide a system for
controlling and enhancing the utilization of repetitive material which
is responsive to department needs and sound from a policy as well as
legal standpoint.

b\. Field Stations have authority to incorporate the centralized DVB
Pattern Library into their local pattern libraries. The pattern letter
library will be under the control of the station PCO. The station PCO
will be the approval authority for any corrections, additions and
deletions to the pattern letter library.

c\. Items may be placed in the local pattern library when printed form
letters are impractical because of too much variation in subject matter
or a printed letter seems inappropriate.

d\. There will be continued review toward improvement of design and
content of existing pattern library items, improvement of operations
through standardization of appropriate new pattern library items, and
effecting economies in administrative control and reproduction costs
through department wide standardization and consolidation of local
pattern library items. Central Office will periodically review the local
libraries to ensure that these standards are met.

**3. DEFINITIONS.** The pattern library will consist of repetitive items
that are pertinent to DVB operations nationwide. The pattern library
items may be a letter, paragraph, text to be included on a form, or
other repetitive material.

**4. RESPONSIBILITIES\--FIELD STATIONS**

a\. Field Station directors will exercise review and control authority
through the designated Station PCO who will act as the controlling
official on all matters pertaining to pattern library activity and
maintain files on the pattern library items. All proposed pattern
library items will be subject to review for determination of
essentiality, coordination, and final approval by the Station PCO. Files
of the pattern library items will be maintained by the Station.

b\. The Station PCO will be responsible for the review, control,
approval, and discontinuance of pattern library items. Since the local
pattern libraries will now incorporate the centralized DVB Pattern
Library, any duplicate items should be merged into one.

**December 9, 1987 DVB Supplement**

**MP-1, Part II**

**Change 29**

c\. At the direction of the Station PCO, local form letters may be
incorporated into the pattern library. Those local letters, where
printed copies will continue to be maintained and used at the station,
will be controlled by following the procedures for local forms and form
letters described in paragraph 4(a) and (b).

d\. All new or proposed pattern library items will be submitted to the
Station PCO for control and numbering using VA Form 20-8953, Request for
New or Revised Pattern Library Item. For reference and history, a
standard numbering system will be used. A numerical prefix to designate
the responsible activity will be as follows:

20 - Used by two or more elements of DVB

21 - Compensation and Pension Service

22 - Vocational Rehabilitation and Education Service (Use this prefix
for Education forms and form letters only)

23 - Administrative Service

24 - Finance

25 - Personnel

26 - Loan Guaranty Service

27 - Veterans Assistance Service

28 - Vocational Rehabilitation and Education Service (use this prefix
for Vocational Rehabilitation and Counseling forms and form letters
only)

29 - Insurance

End of Page 4-5