Regulation for Submission of Evidence - Title 38 CFR 17.101(a)(4)

ICR 200712-2900-029

OMB: 2900-0606

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2008-03-24
IC Document Collections
ICR Details
2900-0606 200712-2900-029
Historical Active 200505-2900-005
VA 2900-0606
Regulation for Submission of Evidence - Title 38 CFR 17.101(a)(4)
Extension without change of a currently approved collection   No
Regular
Approved without change 06/12/2008
Retrieve Notice of Action (NOA) 04/03/2008
  Inventory as of this Action Requested Previously Approved
06/30/2011 36 Months From Approved 07/31/2008
400 0 400
800 0 800
0 0 0

Third-party payers may be asked to provide evidence so VA can determine if the test of properly demonstrating equivalent private sector provider payment has been met.

US Code: 38 USC 1729 Name of Law: Recovery by the United States of the cost of certain
  
None

Not associated with rulemaking

  73 FR 14 01/22/2008
73 FR 63 04/01/2008
No

1
IC Title Form No. Form Name
Regulation for Submission of Evidence - Title 38 CFR 17.101(a)(4)

  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 400 400 0 0 0 0
Annual Time Burden (Hours) 800 800 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$717
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.
04/03/2008


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