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

ICR 201102-2900-006

OMB: 2900-0606

Federal Form Document

Forms and Documents
Document
Name
Status
Supporting Statement A
2011-07-19
IC Document Collections
ICR Details
2900-0606 201102-2900-006
Historical Active 200712-2900-029
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 with change 08/12/2011
Retrieve Notice of Action (NOA) 06/09/2011
  Inventory as of this Action Requested Previously Approved
08/31/2014 36 Months From Approved 08/31/2011
400 0 400
800 0 800
0 0 0

Third-party payers may be asked to provide evidence of payments completed so VA can determine if equivalent private sector provider payment is properly demonstrated.

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

Not associated with rulemaking

  76 FR 46 03/09/2011
76 FR 96 05/18/2011
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

$930
No
No
No
No
No
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.
06/09/2011


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