CHAMPVA Benefits - Application, Claim, Other Health Insurance, Potential Liability & Misc Expenses
Extension without change of a currently approved collection
No
Emergency
03/31/2021
Improperly submitted
03/31/2021
03/25/2021
Emergency review is denied. VA has not demonstrated that it could not have reasonably complied with the normal clearance processes.
table that charts list comparision
Inventory as of this Action
Requested
Previously Approved
6 Months From Approved
03/31/2021
0
0
177,225
0
0
46,176
0
0
0
Civilian Health And Medical Program of the Department of Veterans Affairs (CHAMPVA) Benefits Forms are used by claimants to submit claims for reimbursement for medical care and by VA to determine benefits eligibility, process claims, detect fraud, and recover costs from third parties -- in accordance with 38 U.S.C. Sections 501 and 1781, and 10 U.S.C. Sections 1079 and 1086.
VA Form 10-10d, Application for CHAMPVA Benefits, is used to determine eligibility of persons applying for healthcare benefits under the CHAMPVA program. VA Form 10-7959a, CHAMPVA Claim Form, is used to adjudicate claims for CHAMPVA benefits. The claim form also is instrumental in the detection and prosecution of fraud. VA Form 10-7959c, CHAMPVA Other Health Insurance (OHI) Certification, is used to systematically obtain OHI information and to correctly coordinate benefits among all liable parties. VA Form 10-7959d, CHAMPVA Potential Liability Claim, provides basic information from which potential liability can be assessed. VA Form 10-7959e, VA Claim for Miscellaneous Expenses, is used to adjudicate claims for certain children of Korea and/or Vietnam veterans authorized under 38 U.S.C., chapter 18, as amended by section 401, P.L. 106-419 and section 102, P.L. 108-183.
The Clinical Review and Appeal Process regarding provision of health care for CHAMPVA, and Certain Children of Korea and/or Vietnam Veterans, is necessary to provide an appeals process that VA believes is appropriate as a matter of law and policy.
VA is requesting an emergency 6-month Paperwork Reduction Act (PRA) clearance of the following Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) forms: 10-7959a, CHAMPVA Claim Form, VHA 10-10d, CHAMPVA Application for Benefits, VHA 10-7959c, CHAMPVA Other Health Insurance form, VHA 10-7959d, CHAMPVA Potential Liability Claim, and form VHA 10-7959e, CHAMPVA Misc. Expenses.
Emergency clearance is requested because VA needs to continue providing benefit administration, to include enrollment and medical claims processing, for the 553,878 CHAMPVA beneficiaries and to continue to process the 20+ million medical claims submitted by beneficiaries or on behalf of beneficiaries by their health care providers. The use of regular OMB clearance procedures will not allow for completion of the regular PRA clearance process by the current expiration date for this information collection. OMB PRA approval is respectfully requested by March 31, 2021.
Upon approval of the emergency 6-month clearance, VA will begin the process for a regular 3-year PRA clearance by publishing a 60-day notice in the Federal Register.
US Code:
38 USC Section 1781
Name of Law: Medical care for survivors and dependents of certain veterans
US Code:
42 USC Section 2651
Name of Law: Recovery by United States
US Code:
10 USC Section 1079
Name of Law: Contracts for medical care for spouses and children: plans
US Code:
10 USC Section 1086
Name of Law: Contracts for health benefits for certain members, former members, and their dependents
US Code:
42 USC Section 2652
Name of Law: Regulations
US Code:
42 USC Section 2653
Name of Law: Limitation or repeal of other provisions for recovery of hospital and medical care costs
EO: EO 9397 Name/Subject of EO: Number System for Federal Accounts Relating to Individual Persons
US Code:
38 USC Section 501
Name of Law: Rules and regulations
Any changes in the burden numbers for this information collection are due to adjustments by VA based upon data since OMB approved the last PRA clearance.
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.
CHAMPVA Benefits - Application, Claim, Other Health Insurance & Potential Liability