OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Payment or Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities

ICR 200208-2900-006 · OMB 2900-0620 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
28879 Payment or Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities Migrated
ICR Details
2900-0620 200208-2900-006
Historical Active 200201-2900-025
VA
Payment or Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities
Extension without change of a currently approved collection   No
Regular
Approved without change 10/03/2002
Retrieve Notice of Action (NOA) 08/08/2002
  Inventory as of this Action Requested Previously Approved
11/30/2005 11/30/2005 10/31/2002
241,457 0 241,457
120,729 0 120,729
0 0 0
Vets, vet reps and health care providers submit this data to request reimbursement from federal government for emergency services at a private institution.
None
None
No
1
IC Title Form No. Form Name
Payment or Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities
  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 241,457 241,457 0 0 0 0
Annual Time Burden (Hours) 120,729 120,729 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.
08/08/2002