OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Regulation for Submission of Evidence - Title 38 CFR 17.1C1(a)(2)

ICR 200505-2900-005 · OMB 2900-0606 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
28850 Regulation for Submission of Evidence - Title 38 CFR 17.1C1(a)(2) Migrated
ICR Details
2900-0606 200505-2900-005
Historical Active 200203-2900-001
VA
Regulation for Submission of Evidence - Title 38 CFR 17.1C1(a)(2)
Extension without change of a currently approved collection   No
Regular
Approved without change 07/08/2005
Retrieve Notice of Action (NOA) 05/11/2005
  Inventory as of this Action Requested Previously Approved
07/31/2008 07/31/2008 07/31/2005
400 0 400
800 0 800
0 0 0
Third-party payers may be asked to provide evidence so VA can determine if the test of properly demonstrating equivalent private sector provider payment has been met.
None
None
No
1
IC Title Form No. Form Name
Regulation for Submission of Evidence - Title 38 CFR 17.1C1(a)(2)
  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 400 400 0 0 0 0
Annual Time Burden (Hours) 800 800 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.
05/11/2005