Veteran/Beneficiary Claim for Reimbursement of Travel Expenses (VA Form 10-3542 and BTSSS)

Forms and Documents

Document Name	Status
Form VA Form 10-3542 Veteran/Beneficiary Claim for Reimbursement of Travel Expenses Form and Instruction	Modified
2900-0798_White Paper_Non-Sub Change Req_Vet-Bene Claim for Reimb of Travel Exp_May 2025.docx Justification for No Material/Nonsubstantive Change	2025-05-15
30 Day FRN 2900-0798_41 Comments Received through FedReg_VA Responses.docx Supplementary Document	2024-11-15
30 Day FRN 2900-0798_Additional Comments Rec'd 10-19-24_VA Responses.docx Supplementary Document	2024-11-15
30 Day FRN 2900-0798_Additional Comments Rec'd 10-18-24_VA Responses.docx Supplementary Document	2024-11-15
30 Day FRN 2900-0798_Additional Comments Rec'd 10-16-24 to 10-17-24_VA Responses.docx Supplementary Document	2024-11-15
30 Day FRN 2900-0798_Additional Comments Rec'd 10-11-24 to 10-15-24_VA Responses.docx Supplementary Document	2024-11-15
30 Day FRN 2900-0798_Additional Comments Rec'd 09-23-24 to 10-7-24_VA Responses.docx Supplementary Document	2024-11-15
30 Day FRN 2900-0798_Additional Comments Rec'd 09-20-24 to 09-22-24_VA Responses.docx Supplementary Document	2024-11-15
30 Day FRN 2900-0798_Additional Comments Rec'd 09-19-24_VA Responses.docx Supplementary Document	2024-11-15
30-Day FRN_2900-0798_Veteran-Beneficiary Claim for Reimbursement of Travel Expenses_VA Form 10-3542 and BTSSS_pub 09182024.pdf Supplementary Document	2024-09-18
2900-0798_VeteranBeneficiary Claim for Reimbursement of Travel Expenses_PO Responses to 60-day FRN Comments_05082024.docx Supplementary Document	2024-05-08
60-Day FRN_2900-0798_Veteran-Beneficiary Claim for Reimbursement of Travel Expenses_VA Form 10-3542 and BTSSS_pub 03052024.pdf Supplementary Document	2024-04-26
SSA_2900-0798_Vet-Bene Claim for Reimb of Travel Exp_Non-Sub Change Req_updated May 2025.docx Supporting Statement A	2025-05-22

IC Document Collections

IC ID	Document Title	Status
206581	Veteran/Beneficiary Claim for Reimbursement of Travel Expenses Form and Instruction	Modified

ICR Details

OMB Control No: 2900-0798	ICR Reference No: 202505-2900-003
Status: Received in OIRA	Previous ICR Reference No: 202402-2900-022
Agency/Subagency: VA	Agency Tracking No: 2900-0798
Title: Veteran/Beneficiary Claim for Reimbursement of Travel Expenses (VA Form 10-3542 and BTSSS)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/22/2025

	Requested	Previously Approved
Expiration Date	11/30/2027	11/30/2027
Responses	7,300,000	7,300,000
Time Burden (Hours)	1,216,667	1,216,667
Cost Burden (Dollars)	0	0

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Abstract: Pursuant to 38 U.S.C. 111 and 38 C.F.R. Part 70, Subpart A, the Veterans Health Administration (VHA) Beneficiary Travel (BT) Program provides payments for authorized travel expenses to help Veterans and other beneficiaries obtain care or services from VHA and VA authorized non-VA providers in the community. VHA must administer payments according to statutory mandates, including the Payment Integrity Information Act of 2019 (PIIA) (Public Law 116-117). In compliance with the PIIA and other program requirements, VHA must gather certain information to determine whether BT eligibility and other criteria for approval have been met, and the amount of payment or reimbursement that is authorized under the BT program. Claimants may include Veterans and other BT beneficiaries, and entities or individuals who provided or paid for travel. Claimants may apply for BT reimbursement orally or in writing through VA Form 10-3542 or the Beneficiary Travel Self Service System (BTSSS). This standard collection of information is necessary to enable VHA to provide this benefit and appropriately ensure that funds are being paid to the correct claimant. VA Form 10-3542 has been revised to add intake fields for VHA use only. In the upper right area on page 1, two fields have been added for “Facility ID” and “Claim Received Date.” There are no changes to the estimated numbers of respondents or burden hours

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Authorizing Statute(s): US Code: 38 USC Section 111 Name of Law: Payments or allowances for beneficiary travel
   PL: Pub.L. 116 - 117 1-3 Name of Law: Payment Integrity Information Act
  

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:
	89 FR 15928	03/05/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 76623	09/18/2024
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Veteran/Beneficiary Claim for Reimbursement of Travel Expenses	VA Form 10-3542	Veteran/Beneficiary Claim for Reimbursement of Travel Expenses

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ICR Summary of Burden

	Total Request	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	7,300,000	7,300,000	0	0	0	0
Annual Time Burden (Hours)	1,216,667	1,216,667	0	0	0	0
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: $29,216,875

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

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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: 05/22/2025

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