OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Camp Lejeune Family Member Program - Reimbursement of Certain Medical Expenses

ICR 202112-2900-006 · OMB 2900-0822 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 10-10068c Camp Lejeune Family Member Program Information Update Form Form and Instruction Modified Repair queued
Form 10-10068b Camp Lejeune Family Member Program Treating Physician Report Form and Instruction Modified Repair queued
Form 10-10068a Camp Lejeune Family Member Program Claim Form Form and Instruction Modified Repair queued
Form 10-10068 Camp Lejeune Family Member Program Application Form and Instruction Modified Repair queued
30-day FRN_Camp Lejeune Family Member Program_2900-0822_published 07082022.pdf Supplementary Document Uploaded 2022-07-20 Repair queued
PO Response to Comment_OMB PRA_2900-0822_Camp Lejeune Family Member Program_6.29.22.pdf Supplementary Document Uploaded 2022-06-29 Repair queued
60-day FRN_Camp Lejeune Family Member Program_2900-0822_published 03182022.pdf Supplementary Document Uploaded 2022-06-10 Repair queued
Supporting Statement A_Camp Lejeune Family Member Prog - Reimbursement of Medical Expenses _updated July 2022.docx Supporting Statement A Uploaded 2022-07-20 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
210897 Camp Lejeune Family Member Program Information Update Form Form and Instruction Modified
210896 Camp Lejeune Family Member Program Treating Physician Report Form and Instruction Modified
210895 Camp Lejeune Family Member Program Claim Form Form and Instruction Modified
210894 Camp Lejeune Family Member Program Application Form and Instruction Modified
ICR Details
2900-0822 202112-2900-006
Received in OIRA 201412-2900-005
VA VHA-2900-0822
Camp Lejeune Family Member Program - Reimbursement of Certain Medical Expenses
Reinstatement without change of a previously approved collection   No
Regular 07/20/2022
  Requested Previously Approved
36 Months From Approved
21,720 0
5,838 0
0 0
The Department of Veterans Affairs (VA) promulgates regulations to implement statutory authority to provide reimbursement for hospital care and medical services provided to certain veterans' family members who resided at Camp Lejeune, North Carolina, for at least 30 days during the period beginning on January 1, 1957, and ending on December 31, 1987. Under this rule, VA will reimburse family members for medical expenses incurred as a result of certain illnesses and conditions that may be attributed to exposure to contaminated drinking water at Camp Lejeune during this time period. Reimbursement will be made within the limitations set forth in statute. In order to furnish such care, VA must collect certain information from the family members to ensure that they meet the requirements of the law.
US Code: 38 USC 1787 Name of Law: Health care of family members of veterans stationed at Camp Lejeune, North Carolina
  
US Code: 38 USC 1787 Name of Law: Health care of family members of veterans stationed at Camp Lejeune, North Carolina
Not associated with rulemaking
  87 FR 15492 03/18/2022
87 FR 40884 07/08/2022
Yes
  Total Request 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 21,720 0 0 0 0 21,720
Annual Time Burden (Hours) 5,838 0 0 0 0 5,838
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$133,281
No
    Yes
    Yes
No
No
No
No
Frances O'Donnell 703 405-2449 [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.
07/20/2022