Claim, Authorization & Invoice for Prosthetic Items & Services

ICR 201406-2900-004

OMB: 2900-0188

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Supporting Statement A
2014-08-13
Supplementary Document
2014-06-19
Supplementary Document
2010-12-21
Supplementary Document
2010-12-21
IC Document Collections
ICR Details
2900-0188 201406-2900-004
Historical Active 201007-2900-001
VA 2900-0188
Claim, Authorization & Invoice for Prosthetic Items & Services
Extension without change of a currently approved collection   No
Regular
Approved without change 10/24/2014
Retrieve Notice of Action (NOA) 08/25/2014
  Inventory as of this Action Requested Previously Approved
10/31/2017 36 Months From Approved 10/31/2014
71,200 0 71,200
5,738 0 5,738
0 0 0

Used to determine eligibility, prescribe, authorize and pay for prosthetic devices and glasses, obtain estimates, allow direct purchase and obtain information on loaned devices.

US Code: 38 USC 3903 Name of Law: Limitations on assistance; special training courses
   US Code: 38 USC 3904 Name of Law: Research and development
   US Code: 38 USC 1701(6) Name of Law: Definitions
   US Code: 38 USC 3902 Name of Law: Assistance for providing automobile and adaptive equipment
   US Code: 38 USC 3901 Name of Law: Definitions
  
None

Not associated with rulemaking

  78 FR 35099 06/11/2013
78 FR 58609 09/24/2013
No

  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 71,200 71,200 0 0 0 0
Annual Time Burden (Hours) 5,738 5,738 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$167,113
No
No
No
No
No
Uncollected
Howard Manuel 215 823-4166 howard.manuel@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.
08/25/2014


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