REPORT OF TREATMENT IN HOSPITAL

ICR 199002-2900-008

OMB: 2900-0119

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
147163 Migrated
ICR Details
2900-0119 199002-2900-008
Historical Active 198612-2900-003
VA
REPORT OF TREATMENT IN HOSPITAL
Reinstatement with change of a previously approved collection   No
Regular
Approved without change 03/30/1990
Retrieve Notice of Action (NOA) 02/09/1990
  Inventory as of this Action Requested Previously Approved
12/31/1992 12/31/1992
20,277 0 0
4,055 0 0
0 0 0

THIS FORM LETTER IS USED TO COLLECT INFORMATION FROM THE INSURED'S HOSPITAL TO DETERMINE HIS/HER ELIGIBILITY FOR A CLAIM FOR DISABILITY INSURANCE BENEFITS.

None
None


No

1
IC Title Form No. Form Name
REPORT OF TREATMENT IN HOSPITAL 29-551

  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 20,277 0 0 0 20,277 0
Annual Time Burden (Hours) 4,055 0 0 0 4,055 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.
02/09/1990


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