Payment/Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities, 38 U.S.C. 1725

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
2900-0620 justification.DOC	Supporting Statement A	Uploaded 2008-09-26	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
28880	Payment/Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities, 38 U.S.C. 1725		Modified

ICR Details

OMB Control No: 2900-0620	ICR Reference No: 200806-2900-007
Status: Historical Active	Previous ICR Reference No: 200510-2900-001
Agency/Subagency: VA	Agency Tracking No: 2900-0620
Title: Payment/Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities, 38 U.S.C. 1725
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/08/2009
	Date Received in OIRA: 09/26/2008
Terms of Clearance: Approved consistent with prior terms of clearance: "Approved per VA memo submitted to OMB Nov. 29th clarifying that OMB approved forms accepted by CMS for billing purposes may be used by respondents to submit information under this collection."

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2012	36 Months From Approved	01/31/2009
Responses	330,759	0	294,373
Time Burden (Hours)	82,690	0	147,187
Cost Burden (Dollars)	0	0	0

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Abstract: Vets, vet reps and health care providers submit this data to request reimbursement from the federal government for emergency services at a private institution.

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Authorizing Statute(s): US Code: 38 USC 1725 Name of Law: Reimbursement for Emergency Treatment
   US Code: 38 USC 1705 Name of Law: Management of Health Care: Patient Enrollment System
   US Code: 38 USC 1728 Name of Law: Reimbursement of Certain Medical Expenses
   PL: Pub.L. 106 - 117 101 Name of Law: The Veterans Millennium Health Care and Benefits Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 137	07/16/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 185	09/23/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Payment/Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities, 38 U.S.C. 1725

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ICR Summary of Burden

table that charts list of burden

	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	330,759	294,373	0	0	36,386	0
Annual Time Burden (Hours)	82,690	147,187	0	0	-64,497	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The adjustment of 36,386 forms is a result of an increase in reliance on VA; however, the overall burden on healthcare providers has been decreased by billing forms being auto-generated.

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Annual Cost to Federal Government: $7,334,581

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 09/26/2008

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