APPLICATION FOR READMISSION TO HOSPITAL OR DOMICILIARY

ICR 197908-2900-011

OMB: 2900-0175

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
174432 Migrated
ICR Details
2900-0175 197908-2900-011
Historical Active 197503-2900-005
VA
APPLICATION FOR READMISSION TO HOSPITAL OR DOMICILIARY
No material or nonsubstantive change to a currently approved collection   No
Emergency 08/27/1979
Approved with change 08/27/1979
Retrieve Notice of Action (NOA) 08/27/1979
  Inventory as of this Action Requested Previously Approved
03/31/1980 03/31/1980 03/31/1980
800,000 0 700,000
24,000 0 21,000
0 0 0



None
None


No

1
IC Title Form No. Form Name
APPLICATION FOR READMISSION TO HOSPITAL OR DOMICILIARY VA-10-10R

  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 800,000 700,000 0 0 100,000 0
Annual Time Burden (Hours) 24,000 21,000 0 0 3,000 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
08/27/1979


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