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Federal forms, ICRs, and supporting documents

Information Collection Request

LETTER TO CHAMPVA BENEFICIARIES REQUESTING THEIR SOCIAL SECURITY NUMBERS

ICR 198904-2900-045 · OMB 2900-0499 · 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
174756 LETTER TO CHAMPVA BENEFICIARIES REQUESTING THEIR SOCIAL SECURITY NUMBERS Form Migrated
ICR Details
2900-0499 198904-2900-045
Historical Active 198904-2900-036
VA
LETTER TO CHAMPVA BENEFICIARIES REQUESTING THEIR SOCIAL SECURITY NUMBERS
No material or nonsubstantive change to a currently approved collection   No
Emergency 04/11/1989
Approved with change 04/11/1989
Retrieve Notice of Action (NOA) 04/11/1989
  Inventory as of this Action Requested Previously Approved
02/28/1989 02/28/1989 02/28/1989
53,700 0 53,700
483 0 483
0 0 0
DEPENDENTS OF VETERANS WHO ARE ELIGIBLE FOR CHAMPVA COMPLETE APPLICATI FORM 10-10D TO OBTAIN MEDICAL BENEFITS AVAILABLE TO THEM THROUGH THE VA. FORM 10-10D IS UNDER REVISION TO INCLUDE THE BENEFICIARY SOCIAL SECURITY NUMBER WHICH IS NEEDED BY DOD TO VERIFY CLAIMS PRIOR TO PAYMENT. THIS ONE-TIME COLLECTION IS NECESSARY TO OBTAIN SOCIAL SECURITY NUMBERS UNTIL THAT REVISION IS APPROVED. THE SPONSOR'S SSAN IS ALSO INCLUDED IN THIS FORM.
None
None
No
1
IC Title Form No. Form Name
LETTER TO CHAMPVA BENEFICIARIES REQUESTING THEIR SOCIAL SECURITY NUMBERS FL 10-20876
  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 53,700 53,700 0 0 0 0
Annual Time Burden (Hours) 483 483 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$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.
04/11/1989