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Information Collection Request

REQUEST FOR INFORMATION CONCERNING UNREIMBURSED FAMILY MEDICAL EXPENSES

ICR 198507-2900-003 · OMB 2900-0197 · Historical Active

Forms and Documents
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No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
174483 REQUEST FOR INFORMATION CONCERNING UNREIMBURSED FAMILY MEDICAL EXPENSES Form Migrated
ICR Details
2900-0197 198507-2900-003
Historical Active 198501-2900-008
VA
REQUEST FOR INFORMATION CONCERNING UNREIMBURSED FAMILY MEDICAL EXPENSES
No material or nonsubstantive change to a currently approved collection   No
Emergency 07/16/1985
Approved with change 07/16/1985
Retrieve Notice of Action (NOA) 07/16/1985
  Inventory as of this Action Requested Previously Approved
12/31/1987 12/31/1987 12/31/1987
164,500 0 164,500
14,908 0 74,908
0 0 0
THIS FORM IS FOR THE PRUPOSE OF COLLECTING INFORMATION FOR USE IN DETERMINING MEDICAL EXPENSES WHICH MAY BE DEDUCTED FROM COUNTABLE INCO TO DETERMINE CORRECT PENSION RATES.
None
None
No
1
IC Title Form No. Form Name
REQUEST FOR INFORMATION CONCERNING UNREIMBURSED FAMILY MEDICAL EXPENSES 21-8416A
  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 164,500 164,500 0 0 0 0
Annual Time Burden (Hours) 14,908 74,908 0 -26,217 -33,783 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
$0
No
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.
07/16/1985