Report of Treatment in Hospital (VA FL 29-551)

ICR 201403-2900-003

OMB: 2900-0119

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2014-08-06
IC Document Collections
IC ID
Document
Title
Status
28329 Modified
ICR Details
2900-0119 201403-2900-003
Historical Active 201106-2900-004
VA 2900-0119 VBA-INS-NK
Report of Treatment in Hospital (VA FL 29-551)
Revision of a currently approved collection   No
Regular
Approved without change 11/24/2014
Retrieve Notice of Action (NOA) 09/25/2014
  Inventory as of this Action Requested Previously Approved
11/30/2017 36 Months From Approved 01/31/2015
20,277 0 20,277
4,055 0 4,055
0 0 0

The form letter,VA FL 29-551 is used to collect information from the insured's hospital to determine eligibility for a claim. The information is required by law, 38 USC 1912, 1915, 1942 and 1948.

US Code: 38 USC 1942 Name of Law: Plans of Insurance
   US Code: 38 USC 1948 Name of Law: Total Disability Provision
   US Code: 38 USC 1912 Name of Law: Total Disability Waiver
   US Code: 38 USC 1915 Name of Law: Totla Disability Income Provision
  
None

Not associated with rulemaking

  79 FR 113 06/12/2014
79 FR 170 09/03/2014
No

1
IC Title Form No. Form Name
Report of Treatment in Hospital (FL 29-551) VA FL 29-551 Report of Treatment in Hospital

  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 20,277 20,277 0 0 0 0
Annual Time Burden (Hours) 4,055 4,055 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$137,680
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.
09/25/2014


© 2024 OMB.report | Privacy Policy