Copayment Exemption for Indian Veterans - Documentation of Indian or Urban Indian Status

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 10-334 Tribal Documentation Form	Form and Instruction	Modified	Available
30-day FRN_2900-0920_Copay Exempt for Indian Vets-Documentation_10-334_pub 09102026.pdf	Supplementary Document	Uploaded 2026-09-10	Available
VA-2026-VACO-0001-0218.pdf	Public Comments	Uploaded 2026-08-28	Available
60-day FRN_2900-0920_Copay Exempt for Indian Vets-Documentation_10-334_pub 06292026.pdf	Supplementary Document	Uploaded 2026-06-30	Available
SSA_2900-0920_Copay Exempt for Indian Vets - Documentation of Status_updated Sep 2026.docx	Supporting Statement A	Uploaded 2026-09-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
257252	Documentation of Indian or Urban Indian Status for Veteran Copayment Exemption	Form and Instruction	Modified	Tribal Documentation Form

ICR Details

OMB Control No: 2900-0920	ICR Reference No: 202602-2900-012
Status: Received in OIRA	Previous ICR Reference No: 202303-2900-008
Agency/Subagency: VA	Agency Tracking No: VHA-2900-0920
Title: Copayment Exemption for Indian Veterans - Documentation of Indian or Urban Indian Status
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/10/2026

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	3,000	0
Time Burden (Hours)	750	0
Cost Burden (Dollars)	0	0

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Abstract: The Department of Veterans Affairs (VA) previously amended its medical regulations to implement a statute exempting Indian and urban Indian veterans from copays for the receipt of hospital care or medical services under laws administered by VA. Public Law (PL) 116-315, sec. 3002 of the Johnny Isakson and David P. Roe, M.D. Veterans Health Care and Benefits Improvement Act of 2020 (signed January 5, 2021) amended section 1730A of title 38 U.S.C. to eliminate copays for the receipt of hospital care or medical services under laws administered by VA for veterans who are either Indian or urban Indian, as those terms are defined in section 4 of the Indian Health Care Improvement Act. Section 4 is codified at 25 U.S.C. 1603, and the definitions for Indian and urban Indian are located in paragraphs 13 and 28, respectively, of section 1603. To demonstrate that a veteran meets the definition of Indian or urban Indian, as defined in 25 U.S.C. 1603(13) or (28), VA may ask the veteran to submit documentation to VA. The veteran should use VA Form 10-334 as a cover sheet for submission of documentation requested by VA.

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Authorizing Statute(s): PL: Pub.L. 116 - 315 3002 Name of Law: Veterans Health Care and Benefits Improvement Act of 2020
   US Code: 25 USC 1603 Name of Law: Indian Health Care Improvement 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:
	91 FR 39164	06/29/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 57694	09/10/2026
Did the Agency receive public comments on this ICR? Yes

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

table that charts list of burden

IC Title	Form No.	Form Name
Documentation of Indian or Urban Indian Status for Veteran Copayment Exemption	10-334	Tribal Documentation Form

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ICR Summary of Burden

table that charts list 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	3,000	0	0	3,000	0	0
Annual Time Burden (Hours)	750	0	0	750	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: There is actually a decrease in the estimated annual respondents and burden hours based upon data since the last PRA clearance. (The ICR is displaying an "increase" in the burden hours because this is a reinstatement of the collection.)

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Annual Cost to Federal Government: $72,717

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: 09/10/2026

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