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

ICR 201611-2900-004 · OMB 2900-0789 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
VADIP_Fact_Sheet_v14.pdf Supplementary Document Uploaded 2017-01-11 Available
2900-0789 Application for Dental Insurance_011117.docx Supporting Statement A Uploaded 2017-01-11 Available
IC Document Collections
IC IDCollectionTypeStatusForm
202798 Application Requirements to Receive VA Dental Insurance Plan Benefits under 38 CFR 17.169 Other-Fact Sheet Modified
ICR Details
2900-0789 201611-2900-004
Historical Active 201301-2900-002
VA 2900-0789
Application Requirements to Receive VA Dental Insurance Plan Benefits under 38 CFR 17.169
Extension without change of a currently approved collection   No
Regular
Approved without change 06/13/2017
Retrieve Notice of Action (NOA) 01/11/2017
  Inventory as of this Action Requested Previously Approved
06/30/2020 36 Months From Approved 06/30/2017
283,500 0 283,500
38,350 0 38,350
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
Not associated with rulemaking
  81 FR 75491 10/31/2016
82 FR 3075 01/10/2017
No
1
IC Title Form No. Form Name
Application Requirements to Receive VA Dental Insurance Plan Benefits under 38 CFR 17.169
  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 283,500 283,500 0 0 0 0
Annual Time Burden (Hours) 38,350 38,350 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
No
No
No
No
Uncollected
Cynthia Harvey - Pryor 202 461-5870 [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.
01/11/2017