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Federal forms, ICRs, and supporting documents

Information Collection Request

AUTHORITY AND INVOICE FOR TRAVEL BY AMBULANCE OR OTHER HIRED VEHICLE

ICR 198905-2900-018 · OMB 2900-0341 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
174668 AUTHORITY AND INVOICE FOR TRAVEL BY AMBULANCE OR OTHER HIRED VEHICLE Form Migrated
ICR Details
2900-0341 198905-2900-018
Historical Active 198609-2900-003
VA
AUTHORITY AND INVOICE FOR TRAVEL BY AMBULANCE OR OTHER HIRED VEHICLE
No material or nonsubstantive change to a currently approved collection   No
Emergency 05/05/1989
Approved with change 05/05/1989
Retrieve Notice of Action (NOA) 05/05/1989
  Inventory as of this Action Requested Previously Approved
08/31/1989 08/31/1989 08/31/1989
122,500 0 122,500
4,900 0 4,900
0 0 0
THIS FORM IS USED IN VA FACILITIES TO AUTHORIZE THE USE OF AND PROCESS PAYMENT FOR AMBULANCE AND OTHER HIRED VEHICULAR FORMS OF TRANSPORTATIO FOR ELIGIBLE VETERANS TO AND FROM VA HEALTH CARE FACILITIES FOR EXAMINATION, TREATMENT, OR CARE.
None
None
No
1
IC Title Form No. Form Name
AUTHORITY AND INVOICE FOR TRAVEL BY AMBULANCE OR OTHER HIRED VEHICLE 10-2511
  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 122,500 122,500 0 0 0 0
Annual Time Burden (Hours) 4,900 4,900 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.
05/05/1989