Payment/Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities, 38 U.S.C. 1725

ICR 200806-2900-007

OMB: 2900-0620

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2008-09-26
ICR Details
2900-0620 200806-2900-007
Historical Active 200510-2900-001
VA 2900-0620
Payment/Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities, 38 U.S.C. 1725
Extension without change of a currently approved collection   No
Regular
Approved without change 01/08/2009
Retrieve Notice of Action (NOA) 09/26/2008
Approved consistent with prior terms of clearance: "Approved per VA memo submitted to OMB Nov. 29th clarifying that OMB approved forms accepted by CMS for billing purposes may be used by respondents to submit information under this collection."
  Inventory as of this Action Requested Previously Approved
01/31/2012 36 Months From Approved 01/31/2009
330,759 0 294,373
82,690 0 147,187
0 0 0

Vets, vet reps and health care providers submit this data to request reimbursement from the federal government for emergency services at a private institution.

US Code: 38 USC 1725 Name of Law: Reimbursement for Emergency Treatment
   US Code: 38 USC 1705 Name of Law: Management of Health Care: Patient Enrollment System
   US Code: 38 USC 1728 Name of Law: Reimbursement of Certain Medical Expenses
   PL: Pub.L. 106 - 117 101 Name of Law: The Veterans Millennium Health Care and Benefits Act
  
None

Not associated with rulemaking

  73 FR 137 07/16/2008
73 FR 185 09/23/2008
No

1
IC Title Form No. Form Name
Payment/Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities, 38 U.S.C. 1725

  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 330,759 294,373 0 0 36,386 0
Annual Time Burden (Hours) 82,690 147,187 0 0 -64,497 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
The adjustment of 36,386 forms is a result of an increase in reliance on VA; however, the overall burden on healthcare providers has been decreased by billing forms being auto-generated.

$7,334,581
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.
09/26/2008


© 2024 OMB.report | Privacy Policy