Information Collection

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

IC 28880 under ICR 201408-2900-005 · OMB 2900-0620.

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IC Title:

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

Agency IC Tracking Number:

2900-0620

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 17.1001(b) 42 CFR 424

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

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 461,188

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	461,188	254,117	207,071
Annual IC Time Burden (Hours)	115,298	63,530	51,768
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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