Dental Record Authorization and Invoice for Outpatient Service

Dental Record Authorization and Invoice for Outpatient Service

OMB: 2900-0335

IC ID: 28546

Information Collection (IC) Details

View Information Collection (IC)

Dental Record Authorization and Invoice for Outpatient Service 2900-0335
 
No Modified
 
Required to Obtain or Retain Benefits
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 10-2570d Dental Record Authorization and Invoice for Outpatient Service 2900-0335 VA Form 10-2570d-fill.pdf http://vaww.va.gov/vaforms/ Yes No Fillable Fileable

Health Health Care Services

 

11,000 0
   
Private Sector Businesses or other for-profits
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 11,000 0 0 -1,460 0 12,460
Annual IC Time Burden (Hours) 3,666 0 0 -487 0 4,153
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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