Report of Treatment in Hospital

ICR 199508-2900-041

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
147165 Migrated
ICR Details
2900-0119 199508-2900-041
Historical Inactive 199301-2900-010
VA
Report of Treatment in Hospital
Extension without change of a currently approved collection   No
Regular
Withdrawn and continue 09/18/1995
Retrieve Notice of Action (NOA) 08/28/1995
Withdrawn pursuant to Agency request.
  Inventory as of this Action Requested Previously Approved
04/30/1996 09/30/1998 04/30/1996
20,277 0 0
4,055 0 4,055
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. The information collected is required by law 38 U.S.C. 1912, 1915, 1942, and 1948.

None
None


No

1
IC Title Form No. Form Name
Report of Treatment in Hospital 29-551

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.
08/28/1995


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