AUTHORIZATION AND INVOICE FOR MEDICAL AND HOSPITAL SERVICES

ICR 198107-2900-004

OMB: 2900-0339

Federal Form Document

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Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
2900-0339 198107-2900-004
Historical Active
VA
AUTHORIZATION AND INVOICE FOR MEDICAL AND HOSPITAL SERVICES
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 09/01/1981
Retrieve Notice of Action (NOA) 07/01/1981
  Inventory as of this Action Requested Previously Approved
08/31/1983 08/31/1983
252,500 0 0
10,100 0 0
0 0 0

THIS FORM IS USED IN VA FACILITIES TO AUTHORIZE, AND PROCESS PAYMENT FOR, MEDICAL AND HOSPITAL SERVICES FOR VA BENEFICIARIES FROM OTHER THAN FEDERAL HEALTH CARE PROVIDERS.

None
None


No

1
IC Title Form No. Form Name
AUTHORIZATION AND INVOICE FOR MEDICAL AND HOSPITAL SERVICES 10-7078

  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 252,500 0 0 0 252,500 0
Annual Time Burden (Hours) 10,100 0 0 0 10,100 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.
07/01/1981


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