Approved consistent with the following terms of clearance: OMB encourages VA to continue Departmental efforts aimed at providing respondents with a fully electronic version of associated forms that may be completed and submitted electronically and that include the recognition of electronic signatures.
table that charts list comparision
Inventory as of this Action
Requested
Previously Approved
10/31/2017
36 Months From Approved
10/31/2014
22,213
0
464,155
3,702
0
33,079
0
0
0
VA Form 10-2065 is part of the Decedent Affairs Package. The form is completed during the interview with relatives of the deceased, and identifies the funeral home to which the remains are to be released. The family signs the form designating that it reflects their wishes. It is used as a control document when VA is requested to arrange for the transportation of the deceased from the place of death to the place of burial, and/or when burial is requested in a National Cemetery.
US Code:
38 USC 1728
Name of Law: Reimbursement of certain medical expenses
US Code:
38 USC 111
Name of Law: Payments or allowances for beneficiary travel
US Code:
38 USC 1703
Name of Law: Contracts for hospital care and medical services in non-Department facilities
US Code:
38 USC 1725
Name of Law: Reimbursement for emergency treatment
VA Forms 10-2511; 10-583; and Form 10-7078 are forms that are not completed by respondents. They are internal VA forms, therefore burden hours are no longer applicable.
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.
Form 10-583 Claim for Payment of Cost of Unauthorized Medical Services; Funeral Arrangements; Authority and Invoice for Travel by Ambulance or Other Hired Vehicle; Authorization and Invoice...
Memo Request to Discontinue VA Form.docx
Claim for Payment of Cost of Unauthorized Medical Services; Funeral Arrangements; Authority and Invoice for Travel by Ambulance or Other Hired Vehicle; Authorization and Invoice...