Information Collection

Payment/Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities, 38 U.S.C. 1725

IC 28880 under ICR 201110-2900-004 · OMB 2900-0620.

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Information Collection (IC) Details

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IC Title:	Payment/Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities, 38 U.S.C. 1725	Agency IC Tracking Number:	2900-0620

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 424 38 CFR 17.1001(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 207,071	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	207,071	-123,688	330,759
Annual IC Time Burden (Hours)	51,768	-30,922	82,690
Annual IC Cost Burden (Dollars)	0	0	0

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