Claim, Authorization & Invoice for Prosthetic Items & Services

ICR 200707-2900-035

OMB: 2900-0188

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2007-11-01
IC Document Collections
ICR Details
2900-0188 200707-2900-035
Historical Active 200409-2900-003
VA 2900-0188
Claim, Authorization & Invoice for Prosthetic Items & Services
Extension without change of a currently approved collection   No
Regular
Approved without change 12/05/2007
Retrieve Notice of Action (NOA) 11/01/2007
  Inventory as of this Action Requested Previously Approved
12/31/2010 36 Months From Approved 12/31/2007
71,200 0 697,200
5,738 0 48,522
0 0 0

Used to determine eligibility, prescribe, authorize and pay for prosthetic devices and glasses, obtain estimates, allow direct purchase and obtain information on loaned devices.

US Code: 38 USC 3901 Name of Law: Definitions
   US Code: 38 USC 3902 Name of Law: Assistance for providing automobile and adaptive equipment
   US Code: 38 USC 3903 Name of Law: Limitations on assistance; special training courses
   US Code: 38 USC 3904 Name of Law: Research and development
   US Code: 38 USC 1701(6) Name of Law: Definitions
  
None

Not associated with rulemaking

  72 FR 152 08/08/2007
72 FR 199 10/16/2007
No

  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 71,200 697,200 0 0 -626,000 0
Annual Time Burden (Hours) 5,738 48,522 0 0 -42,784 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
10-1394 - Using FY06 and FY07 1st and 2nd quarter data, Prosthetics can better estimate the number of automobile adaptive claims filed on 10-1394. There has been no significant change in workload or procedure, but rather more accurate data collection over the years. 10-2421 - Since our last request, Prosthetics services have moved towards the goal of 100% purchase card use; however, we cannot mandate that all vendors accept purchase cards. Due to this, we anticipate a sharp decline in the use of 10-2421. 10-2914 - Since our last request, eyeglass consults have been standardized in the VA’s Computerized Patient Record System. VA uses fee basis or contract providers to meet their eyeglass prescription needs. These fee basis/contract prescriptions must still be provided on 10-2914. 10-426 - Loan Follow-up Letter, is no longer used because the loan program has been discontinue.

$113,736
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Denise McLamb 202-565-8374 denise.mclamb@mail.va.gov

  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.
11/01/2007


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