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Federal forms, ICRs, and supporting documents

Information Collection

Authorization And Invoice For Medical And Hospital Services, Claim For Payment Of Unauthorized Medical Services, Authority & Invoice For Travel By Ambulance Or...

IC 146932 under ICR 199108-2900-003 · OMB 2900-0080.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
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Information Collection (IC) Details

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Information Collection Instruments:
table that charts list of instruments
Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA 10-7078 No No
Form 10-583 No No
Form 10-2511 No No

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 443,250 0 0 443,250 0 0
Annual IC Time Burden (Hours) 29,500 0 0 29,500 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
Title Document Date Uploaded
 
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.