Funeral Arrangements

ICR 201606-2900-005

OMB: 2900-0080

Federal Form Document

Forms and Documents
Document
Name
Status
Form
Modified
Justification for No Material/Nonsubstantive Change
2016-06-30
Supplementary Document
2013-10-27
Supplementary Document
2013-10-27
Supporting Statement A
2014-03-13
IC Document Collections
IC ID
Document
Title
Status
210686 Modified
ICR Details
2900-0080 201606-2900-005
Historical Active 201310-2900-001
VA 2900-0080
Funeral Arrangements
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 07/12/2016
Retrieve Notice of Action (NOA) 07/12/2016
  Inventory as of this Action Requested Previously Approved
10/31/2017 10/31/2017 10/31/2017
22,213 0 22,213
3,702 0 3,702
0 0 0

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.

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
  
None

Not associated with rulemaking

  79 FR 3275 01/17/2014
79 FR 25191 05/02/2014
No

1
IC Title Form No. Form Name
Funeral Arrangements Request Form 10-2065 FUNERAL ARRANGEMENTS

  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
No
No

$60,160
No
No
No
No
No
Uncollected
Cynthia Harvey - Pryor 202 461-5870 cynthia.harvey-pryor@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.
07/12/2016


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