Application for Change of Permanent Plan (Medical)

ICR 201307-2900-004

OMB: 2900-0179

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supplementary Document
2014-04-22
Supplementary Document
2014-04-22
Supporting Statement A
2014-04-22
IC Document Collections
IC ID
Document
Title
Status
28423 Modified
ICR Details
2900-0179 201307-2900-004
Historical Active 201012-2900-005
VA 2900-0179 VBA-INS-YM
Application for Change of Permanent Plan (Medical)
Revision of a currently approved collection   No
Regular
Approved without change 07/08/2014
Retrieve Notice of Action (NOA) 05/05/2014
  Inventory as of this Action Requested Previously Approved
07/31/2017 36 Months From Approved 07/31/2014
28 0 28
14 0 14
0 0 0

This form is designed for use by the insured to establish eligibility to change insurance plans. The information is authorized by law, 38 CFR Section 6.48 and 8.36.

US Code: 38 USC 1944 Name of Law: Policy provisions
   US Code: 38 USC 1906 Name of Law: Policy provisions
  
None

Not associated with rulemaking

  78 FR 147 07/31/2013
79 FR 24 02/05/2014
No

1
IC Title Form No. Form Name
Application for Change of Permanent Plan (Medical) VA Form 29-1549 Application for Change of Permanent Plan (Medical)

  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 28 28 0 0 0 0
Annual Time Burden (Hours) 14 14 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$207
No
No
No
No
No
Uncollected
Crystal Rennie 202 632-7492 crystal.rennie@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.
05/05/2014


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