Information Collection

Certification Of Delivery Of Advance Payment And Enrollment

IC 147952 under ICR 199210-2900-005 · OMB 2900-0325.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0325 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	CERTIFICATION OF DELIVERY OF ADVANCE PAYMENT AND ENROLLMENT	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA 22-1999V				No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,168	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	39,135	635	38,500
Annual IC Time Burden (Hours)	3,261	53	3,208
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.