Veteran Reimbursement Claim Form (10-320)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10-320 Veteran Reimbursement Claim Form	Form and Instruction	New	Available
Form 10-320 Veteran Reimbursement Claim Form	Form and Instruction	New	Repair queued
30-Day FRN_2900-NEW_Veteran Reimbursement Claim Form_published 01022024.pdf	Supplementary Document	Uploaded 2024-01-31	Repair queued
60-Day FRN_2900-NEW_Veteran Reimbursement Claim Form_published 10272023.pdf	Supplementary Document	Uploaded 2024-02-01	Repair queued
Supporting Statement A_2900-NEW_Veteran Reimbursement Claim - VA Form 10-320_updated Jan 2024.docx	Supporting Statement A	Uploaded 2024-02-01	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
262985	Veteran Reimbursement Claim Form	Form and Instruction	New	Veteran Reimbursement Claim Form
262985	Veteran Reimbursement Claim Form	Form and Instruction	New

ICR Details

OMB Control No: 2900-0940	ICR Reference No: 202310-2900-005
Status: Active	Previous ICR Reference No:
Agency/Subagency: VA	Agency Tracking No: 2900-NEW
Title: Veteran Reimbursement Claim Form (10-320)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/27/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 02/01/2024
Terms of Clearance: OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2027	36 Months From Approved
Responses	85,700	0	0
Time Burden (Hours)	14,283	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: Veterans may claim reimbursement for certain medical costs, as authorized by 38 U.S.C. 1728. The new Veteran Reimbursement Claim Form, VA Form 10-320, will be utilized by Veterans requesting reimbursement for various out-of-pocket expenses that occurred as a result of non-VA medical services that may be eligible for payment under 38 CFR 17.4025 (Veterans Community Care Program), 38 CFR 17.120 (Unauthorized), 38 CFR 17.1002 (Millennium Bill), and 38 CFR 17.1200--17.1230 (COMPACT Act). In order for VA to process and repay these expenses, Veterans must submit necessary information to explain their request and justify reimbursement. Veterans may use this form to submit claims for reimbursement for pharmacy costs, training classes, emergent suicide care, and other medical expenses.

---

Authorizing Statute(s): US Code: 38 USC 1728 Name of Law: Reimbursement of certain medical expenses
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 73942	10/27/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 123	01/02/2024
Did the Agency receive public comments on this ICR? No

---

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

table that charts list of burden

IC Title	Form No.	Form Name
Veteran Reimbursement Claim Form	10-320	Veteran Reimbursement Claim Form

---

ICR Summary of Burden

table that charts list 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	85,700	0	0	85,700	0	0
Annual Time Burden (Hours)	14,283	0	0	14,283	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new collection, and all burden hours are considered a program increase.

---

Annual Cost to Federal Government: $2,254,695

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? No

---

Common Form ICR:  No

---

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: 02/01/2024

---