Information Collection

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

IC 256605 under ICR 202602-2900-011 · OMB 2900-0924.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-314 Request for Payment of Bowel and Bladder Services VA Form 10-314 - Request for Payment of Bowel and Bladder Services	Form
10-314 Request for Payment of Bowel and Bladder Services VA Form 10-314_updated 2026.pdf	Form

IC Title:

Agency IC Tracking Number:

VHA-2900-0924

Is this a Common Form? No

IC Status: Modified

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				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: 23VA10NB3

FR Citation: 90 FR 39485

Number of Respondents: 3,100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	37,200	37,200
Annual IC Time Burden (Hours)	6,200	6,200
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.

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].