OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Camp Lejeune Family Member Program - Reimbursement of Certain Medical Expenses

ICR 202504-2900-009 · OMB 2900-0822 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 10-10068c Camp Lejeune Family Member Program - Information Update Form Form and Instruction Modified Available
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 10-10068b 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 Available
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 Available
Form 10-10068 Camp Lejeune Family Member Program - Application Form and Instruction Modified Repair queued
VHA 30-Day FRN_Public Comment Response_2900-0822_CLFMP_08192025.pdf Supplementary Document Uploaded 2025-08-27 Repair queued
VHA 60-day FRN_Public Comment Response_2900-0822_CLFMP_08072025.pdf Supplementary Document Uploaded 2025-08-19 Repair queued
PC_202504-2900-009_080525_100215_1.pdf Public Comments Uploaded 2025-08-05 Repair queued
VA-2025-VACO-0001-0062.pdf Public Comments Uploaded 2025-07-26 Repair queued
30-day FRN_2900-0822_Camp Lejeune Family Member Program_pub 08012025.pdf Supplementary Document Uploaded 2025-08-01 Repair queued
30-day FRN_2900-0822_Camp Lejeune Family Member Program_pub 08012025.pdf Supplementary Document Uploaded 2025-08-01 Repair queued
60-day FRN_2900-0822_Camp Lejeune Family Member Program_pub 05292025.pdf Supplementary Document Uploaded 2025-06-09 Repair queued
60-day FRN_2900-0822_Camp Lejeune Family Member Program_pub 05292025.pdf Supplementary Document Uploaded 2025-06-09 Repair queued
SSA_2900-0822_Camp Lejeune Family Member Prog - Reimb of Medical Exp _updated Aug 2025.docx Supporting Statement A Uploaded 2025-08-01 Repair queued
SSA_2900-0822_Camp Lejeune Family Member Prog - Reimb of Medical Exp _updated Aug 2025.docx Supporting Statement A Uploaded 2025-08-01 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
210897 Camp Lejeune Family Member Program - Information Update Form Form and Instruction ModifiedCamp Lejeune Family Member Program - Information Update Form
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 ModifiedCamp Lejeune Family Member Program - Treating Physician Report
210896 Camp Lejeune Family Member Program - Treating Physician Report Form and Instruction Modified
210895 Camp Lejeune Family Member Program - Claim Form Form and Instruction ModifiedCamp Lejeune Family Member Program - Claim Form
210895 Camp Lejeune Family Member Program - Claim Form Form and Instruction Modified
210894 Camp Lejeune Family Member Program - Application Form and Instruction ModifiedCamp Lejeune Family Member Program - Application
210894 Camp Lejeune Family Member Program - Application Form and Instruction Modified
ICR Details
2900-0822 202504-2900-009
Active 202112-2900-006
VA VHA-2900-0822
Camp Lejeune Family Member Program - Reimbursement of Certain Medical Expenses
Revision of a currently approved collection   No
Regular
Approved without change 09/03/2025
Retrieve Notice of Action (NOA) 08/01/2025
OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action.
  Inventory as of this Action Requested Previously Approved
09/30/2028 36 Months From Approved 09/30/2025
23,349 0 21,720
6,246 0 5,838
0 0 0
Under 38 U.S.C. 1787, VA is required to furnish hospital care and medical services to the family members of certain veterans who were stationed at Camp Lejeune between 1953 and 1987. In order to furnish such care, VA must collect necessary information from the family members to ensure that they meet the requirements of the law. The specific hospital care and medical services that VA must provide are for a number of illnesses and conditions connected to exposure to contaminated drinking water while at Camp Lejeune. VA will furnish Camp Lejeune family members with hospital care and medical services for 15 illnesses and conditions that are life threatening and require immediate medical intervention. The forms in this collection will be used to determine eligibility and reimbursement for this medical care. Some minor changes to the wording in VA Form 10-10068b have been made to clarify the information being collected from the treating physician. Also, VA Form 10-10068b may now be used up to two times annually per patient, and there is an associated increase in the estimated burden hours.
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
  90 FR 22832 05/29/2025
90 FR 36286 08/01/2025
Yes
  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 23,349 21,720 0 1,629 0 0
Annual Time Burden (Hours) 6,246 5,838 0 408 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The burden hours have increased due to an increase in the use of VA Form 10-10068b from once annually to two times per year.
$194,562
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.
08/01/2025