VA Meds by Mail

ICR 201412-2900-007

OMB: 2900-0832

Federal Form Document

Forms and Documents
IC Document Collections
IC ID
Document
Title
Status
214210 New
ICR Details
2900-0832 201412-2900-007
Historical Active
VA
VA Meds by Mail
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 06/22/2015
Retrieve Notice of Action (NOA) 02/22/2015
  Inventory as of this Action Requested Previously Approved
06/30/2018 36 Months From Approved
220,000 0 0
18,333 0 0
0 0 0

VA Form 10-0426, Meds by Mail (MbM) Order Form, is used by eligible CHAMPVA and Spina Bifida beneficiaries (also referred to as patient) in accordance with 38 CFR Sections 17.270, 17.271 and 17.272 when submitting a paper prescription written by their medical provider for fulfillment through the Meds by Mail Program. Information collected on this form is necessary for proper patient identification and medical record review.

None
None

Not associated with rulemaking

  79 FR 60896 10/08/2014
79 FR 77098 12/23/2014
No

1
IC Title Form No. Form Name
VA Meds by Mail Order Form 10-10068 VA meds by mail order form

  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 220,000 0 0 220,000 0 0
Annual Time Burden (Hours) 18,333 0 0 18,333 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new collection and all burden hours are considered a program increase.

$633,006
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.
02/22/2015


© 2024 OMB.report | Privacy Policy