INSURANCE INFORMATION

ICR 198605-2900-002

OMB: 2900-0472

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
148291 Migrated
ICR Details
2900-0472 198605-2900-002
Historical Active
VA
INSURANCE INFORMATION
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 07/01/1986
Retrieve Notice of Action (NOA) 05/21/1986
  Inventory as of this Action Requested Previously Approved
06/30/1989 06/30/1989
60,000 0 0
12,000 0 0
0 0 0

THIS FORM WILL BE USED TO RECORD INFORMATION ON HEALTH INSURANCE POLICIES PROVIDING COVERAGE FOR CARE FURNISHED TO NONSERVICE-CONNECTED VETERANS.

None
None


No

1
IC Title Form No. Form Name
INSURANCE INFORMATION VA 10-10I

  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 60,000 0 0 60,000 0 0
Annual Time Burden (Hours) 12,000 0 0 12,000 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
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.
05/21/1986


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