Documentation of Indian or Urban Indian Status for Veteran Copayment Exemption

Copayment Exemption for Indian Veterans (AR48) - Documentation of Indian or Urban Indian Status

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0920 can be found here:

Documents and Forms

Document Name Document Type

no available documents/forms check other ICs listed under this ICR

Information Collection (IC) Details

IC Title:	Documentation of Indian or Urban Indian Status for Veteran Copayment Exemption	Agency IC Tracking Number:	2900-NEW

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 17.108 38 CFR 17.110 38 CFR 17.111 38 CFR 17.4600

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 24VA19 “Patient Medical Record – VA"	FR Citation: 74 FR 60040

Number of Respondents: 25,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	25,000	25,000
Annual IC Time Burden (Hours)	6,250	6,250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.