Information Collection

VA Medical Center Payment Form

IC 192600 under ICR 201004-2900-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-0505 VA Medical Center Payment Form	Form
VA Form 10-0505 VA Medical Center Payment Medical Center Payment form.pdf www.pay.gov/paygov/browseAgencyIntro.html	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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 Form 10-0505	VA Medical Center Payment	Medical Center Payment form.pdf	https://www.pay.gov/paygov/browseAgencyIntro.html	Yes	Yes	Fillable Fileable

Line of Business: General Government

Subfunction: Central Fiscal Operations

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	720,000	720,000
Annual IC Time Burden (Hours)	48,000	48,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.