Funeral Arrangements

Forms and Documents

Document Name	Status
Form 10-2065 Funeral Arrangements Request Form Form	Modified
061616_White Paper for Change to Funeral Arrangements Application.docx Justification for No Material/Nonsubstantive Change	2016-06-30
Memo Request to Discontinue VA Form.docx Supplementary Document	2013-10-27
Memo for Revisions to 2900-0080.docx Supplementary Document	2013-10-27
2900-0080 Justification_20140313 (v4).docx Supporting Statement A	2014-03-13

IC Document Collections

IC ID	Document Title	Status
210686	Funeral Arrangements Request Form Form	Modified

ICR Details

OMB Control No: 2900-0080	ICR Reference No: 201606-2900-005
Status: Historical Active	Previous ICR Reference No: 201310-2900-001
Agency/Subagency: VA	Agency Tracking No: 2900-0080
Title: Funeral Arrangements
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/12/2016
	Date Received in OIRA: 07/12/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2017	10/31/2017	10/31/2017
Responses	22,213	0	22,213
Time Burden (Hours)	3,702	0	3,702
Cost Burden (Dollars)	0	0	0

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Abstract: VA Form 10-2065 is part of the Decedent Affairs Package. The form is completed during the interview with relatives of the deceased, and identifies the funeral home to which the remains are to be released. The family signs the form designating that it reflects their wishes. It is used as a control document when VA is requested to arrange for the transportation of the deceased from the place of death to the place of burial, and/or when burial is requested in a National Cemetery.

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Authorizing Statute(s): US Code: 38 USC 1725 Name of Law: Reimbursement for emergency treatment
   US Code: 38 USC 1728 Name of Law: Reimbursement of certain medical expenses
   US Code: 38 USC 111 Name of Law: Payments or allowances for beneficiary travel
   US Code: 38 USC 1703 Name of Law: Contracts for hospital care and medical services in non-Department facilities
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 3275	01/17/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 25191	05/02/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Funeral Arrangements Request Form	10-2065	FUNERAL ARRANGEMENTS

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ICR Summary of Burden

	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	22,213	22,213	0	0	0	0
Annual Time Burden (Hours)	3,702	3,702	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $60,160

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 07/12/2016

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