Funeral Arrangements

Forms and Documents

Document Name	Status
Form 10-2065 Funeral Arrangements Request Form Form	Unchanged
30 Day FRN - Published.pdf Supplementary Document	2018-07-12
2900-0080 Justification_Reinstatement_Updated BLS_050418.docx Supporting Statement A	2018-07-17
60 day FRN - Published.pdf Supplementary Document	2018-05-04

IC Document Collections

IC ID	Document Title	Status
210686	Funeral Arrangements Request Form Form	Unchanged

ICR Details

OMB Control No: 2900-0080	ICR Reference No: 201711-2900-003
Status: Active	Previous ICR Reference No: 201606-2900-005
Agency/Subagency: VA	Agency Tracking No: 2900-0080
Title: Funeral Arrangements
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 08/30/2018
	Date Received in OIRA: 07/17/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2021	36 Months From Approved
Responses	22,213	0	0
Time Burden (Hours)	3,702	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: 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.

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Authorizing Statute(s): 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
  

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:
	82 FR 52970	11/15/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 21340	05/09/2018
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
Funeral Arrangements Request Form	10-2065	FUNERAL ARRANGEMENTS

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ICR Summary 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	22,213	0	0	0	0	22,213
Annual Time Burden (Hours)	3,702	0	0	0	0	3,702
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:

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Annual Cost to Federal Government: $60,160

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

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: 07/17/2018

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