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CHAMPVA Clinical Review
CHAMPVA Benefits - Application, Claim, Other Health Insurance, Potential Liability & Misc Expenses
OMB: 2900-0219
IC ID: 246422
OMB.report
VA
OMB 2900-0219
ICR 202102-2900-011
IC 246422
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0219 can be found here:
2024-10-30 - Revision of a currently approved collection
2021-09-09 - Reinstatement with change of a previously approved collection
Documents and Forms
Document Name
Document Type
no available documents/forms check other ICs listed under this ICR
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
CHAMPVA Clinical Review
Agency IC Tracking Number:
2900-0219
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
38 CFR 1.900
38 CFR 17.900 through 17.905
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
2,332
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
2,332
0
2,332
0
0
0
Annual IC Time Burden (Hours)
777
0
777
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.