Approved consistent with the following terms of clearance: OMB encourages VA to continue Departmental efforts aimed at providing respondents with a fully electronic version of associated forms that may be completed and submitted electronically and that include the recognition of electronic signatures.
Inventory as of this Action
Requested
Previously Approved
02/28/2011
36 Months From Approved
02/29/2008
440,380
0
434,250
30,391
0
31,546
0
0
0
These forms are used to initiate and document expenditures, to claim reimbursement as well as make funeral arrangements, authorize burial benefits and other micellaneous medical services.
US Code:
38 USC 1728
Name of Law: Reimbursement of certain medical expenses
US Code:
38 USC 111
Name of Law: Payments or allowances for beneficiary travel
US Code:
38 USC 1703
Name of Law: Contracts for hospital care and medical services in non-Department facilities
US Code:
38 USC 1725
Name of Law: Reimbursement for emergency treatment
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.
Form 10-583 Claim for Payment of Cost of Unauthorized Medical Services; Funeral Arrangements; Authority and Invoice for Travel by Ambulance or Other Hired Vehicle; Authorization and Invoice...
supporting statement 10-583.DOC
Claim for Payment of Cost of Unauthorized Medical Services; Funeral Arrangements; Authority and Invoice for Travel by Ambulance or Other Hired Vehicle; Authorization and Invoice...