Prescription, Authorization, Application, Procurement, Repair and Loan of Prosthetic Items

ICR 199508-2900-014

OMB: 2900-0188

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
2900-0188 199508-2900-014
Historical Active 199112-2900-004
VA
Prescription, Authorization, Application, Procurement, Repair and Loan of Prosthetic Items
Reinstatement without change of a previously approved collection   No
Regular
Approved without change 09/19/1995
Retrieve Notice of Action (NOA) 08/23/1995
  Inventory as of this Action Requested Previously Approved
09/30/1998 09/30/1998
512,844 0 0
36,496 0 0
0 0 0

With these forms and form letters, we effectively manage the prosthetics program. They are used to determine eligibility, prescribe, and authorize prosthetic devices as well as to obtain estimates, allow for direct purchase and obtain information on loaned devices.

None
None


No

1
IC Title Form No. Form Name
Prescription, Authorization, Application, Procurement, Repair and Loan of Prosthetic Items FL10-426, VAF10-2421, VAF10-2914, VAF10-2520, VAF10-90, VAF10-1394

  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 512,844 0 0 512,844 0 0
Annual Time Burden (Hours) 36,496 0 0 36,496 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.
08/23/1995


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