OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201408-2900-005 · OMB 2900-0620 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
201408-2900-005_VA Pay Reimb for Emer Svcs-Non VA Facilities justification - FINAL-no comments.doc Supporting Statement A Uploaded 2015-07-08 Available
IC Document Collections
IC IDCollectionTypeStatusForm
28880 Payment/Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities, 38 U.S.C. 1725 Modified
ICR Details
2900-0620 201408-2900-005
Historical Active 201110-2900-004
VA 2900-0620
Payment/Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities, 38 U.S.C. 1725
Revision of a currently approved collection   No
Regular
Approved without change 07/09/2015
Retrieve Notice of Action (NOA) 02/17/2015
  Inventory as of this Action Requested Previously Approved
07/31/2018 36 Months From Approved 07/31/2015
461,188 0 207,071
115,298 0 51,768
0 0 0
Vets, vet reps and health care providers submit this data to request reimbursement from the federal government for emergency services at a private institution.
US Code: 38 USC 1705 Name of Law: Management of Health Care: Patient Enrollment System
   US Code: 38 USC 1728 Name of Law: Reimbursement of Certain Medical Expenses
   PL: Pub.L. 106 - 117 101 Name of Law: The Veterans Millennium Health Care and Benefits Act
   US Code: 38 USC 1725 Name of Law: Reimbursement for Emergency Treatment
  
None
Not associated with rulemaking
  79 FR 61690 10/14/2014
79 FR 77098 12/23/2014
No
1
IC Title Form No. Form Name
Payment/Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities, 38 U.S.C. 1725
  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 461,188 207,071 0 254,117 0 0
Annual Time Burden (Hours) 115,298 51,768 0 63,530 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The adjustment of +130,429 forms is a result of an increase in reliance on VA for the payment of emergency non-VA health care under the authority of 38 U.S.C. 1725.
$10,474,731
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.
02/17/2015