Millennium Bill Emergency Care Provider Satisfaction Survey

Forms and Documents

Document Name	Status
Form VA Form 10-0473 Millennium Bill Emergency Care Provider Satisfaction Survey Form	New
Mill Bill Survey Advance Notification Letter_07-07-10.doc Supplementary Document	2011-02-01
Mill Bill Survey Reminder Letter_07-07-10.doc Supplementary Document	2011-02-01
VA Form 10-0473 10-19.doc Supplementary Document	2011-02-01
10-0473 Justification A.doc Supporting Statement A	2009-12-08
10-0473 Justification B.doc Supporting Statement B	2009-12-08
Mill Bill Survey Advance Notification Letter.doc Supplementary Document	2009-11-18

IC Document Collections

IC ID	Document Title	Status
190127	Millennium Bill Emergency Care Provider Satisfaction Survey Form	New

ICR Details

OMB Control No: 2900-0763	ICR Reference No: 200907-2900-010
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No:
Title: Millennium Bill Emergency Care Provider Satisfaction Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/25/2011
	Date Received in OIRA: 12/08/2009
Terms of Clearance: Approved consistent with revised VA materials.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2014	36 Months From Approved
Responses	110	0	0
Time Burden (Hours)	9	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: In an effort to improve service delivery, reduce program costs, minimize payment errors and increase the timeliness of reimbursements to non-VA healthcare providers and Veterans, VHA Chief Business Office (CBO) has re engineered its end-to-end automated process for healthcare claims processing for claims from non-VA providers. CBO is evaluating the performance of the VA Financial Service Center (FSC), a franchise fund organization of the VA where non-VA claims processing efforts have been consolidated for two Veterans Integrated Service Networks (VISN.

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Authorizing Statute(s): US Code: 38 USC Part I, Chapter 5, Section 527 Name of Law: Evaluation and data collection
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 173	09/09/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 220	11/17/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Millennium Bill Emergency Care Provider Satisfaction Survey	VA Form 10-0473	Millennium Bill Emergency Care Provider Satisfaction Survey

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ICR Summary of Burden

	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	110	0	0	110	0	0
Annual Time Burden (Hours)	9	0	0	9	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection and all burden hours are considered a program increase.

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Annual Cost to Federal Government: $75,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 12/08/2009

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