Approved for use
through 10/2001 under the condition that the VA displays the
expiration date for OMB approval. OMB does not approve the VA's
request for a waiver of this requirement.
Inventory as of this Action
Requested
Previously Approved
10/31/2001
10/31/2001
2,372,766
0
0
681,192
0
0
0
0
0
This form collects information from
the veterans and the veterans' spouse to enroll for VA health care
benefits or CHAMPVA benefits. This form establishes basic
eligibility, identifies veterans who have third-party health
insurance for billing purposes, and veterans exempt from
prescription copayment.
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.