Information Collection

VA Form 10-314 - Request for Payment of Bowel and Bladder Services

IC 256605 under ICR 202207-2900-006 · OMB 2900-0924.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-314b VA Form 10-314b - Request for Payment of Bowel and Bladder Services	Form
10-314b Request for Payment of Bowel and Bladder Services 10-314b_Request for Payment of Bowel and Bladder Services.pdf	Form
10-314 Request for Payment of Bowel and Bladder Services VA Form 10-314_rev April 2023.pdf	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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
Form	10-314	Request for Payment of Bowel and Bladder Services	VA Form 10-314_rev April 2023.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	40,800	40,800
Annual IC Time Burden (Hours)	6,800	6,800
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.