OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Application Requirements to Receive VA Dental Insurance Plan Benefits under 38 CFR 17.169; RIN 2900-AN99

ICR 201301-2900-002 · OMB 2900-0789 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
VADIP_Fact_Sheet_v14.pdf Supplementary Document Uploaded 2014-01-28 Repair queued
DownloadNOA.pdf Supplementary Document Uploaded 2013-08-26 Repair queued
2900-0789 Application for Dental Insurance.docx Supporting Statement A Uploaded 2013-01-09 Available
IC Document Collections
IC IDCollectionTypeStatusForm
202798 Application Requirements to Receive VA Dental Insurance Plan Benefits under 38 CFR 17.169; RIN 2900-AN99 Other-Fact Sheet Modified
ICR Details
2900-0789 201301-2900-002
Historical Active 201206-2900-010
VA
Application Requirements to Receive VA Dental Insurance Plan Benefits under 38 CFR 17.169; RIN 2900-AN99
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 01/30/2014
Retrieve Notice of Action (NOA) 09/03/2013
  Inventory as of this Action Requested Previously Approved
01/31/2017 36 Months From Approved
283,500 0 0
38,350 0 0
0 0 0
Section 510 of title III of the Caregivers and Veterans Omnibus Health Services Act of 2010 (section 510) requires VA to establish a new program to offer private, premium-based dental insurance to enrolled veterans and certain survivors and dependents of veterans. Section 510 requires VA to contract with a private insurer (using the Federal contracting process) to offer dental insurance, and the private insurer will be responsible for virtually all aspects of the administration of the dental insurance program.
PL: Pub.L. 111 - 163 510(C) Name of Law: Pilot program on provision of dental insurance plans to
  
None
2900-AN99 Final or interim final rulemaking 77 FR 41 03/01/2012
No
1
IC Title Form No. Form Name
Application Requirements to Receive VA Dental Insurance Plan Benefits under 38 CFR 17.169; RIN 2900-AN99
  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 283,500 0 0 283,500 0 0
Annual Time Burden (Hours) 38,350 0 0 38,350 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new collection request for clearance of OMB control number 2900-0789, as provided by OMB for placement in publishing the Final Rule (RIN 2900-AN99).
$0
No
No
No
No
No
Uncollected
Crystal Rennie 202 632-7492 [email protected]
  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.
09/03/2013