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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
2900-0188
ICR Reference No:
200707-2900-035
Status:
Historical Active
Previous ICR Reference No:
200409-2900-003
Agency/Subagency:
VA
Agency Tracking No:
2900-0188
Title:
Claim, Authorization & Invoice for Prosthetic Items & Services
Type of Information Collection:
Extension without change of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
12/05/2007
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/01/2007
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
12/31/2010
36 Months From Approved
12/31/2007
Responses
71,200
0
697,200
Time Burden (Hours)
5,738
0
48,522
Cost Burden (Dollars)
0
0
0
Abstract:
Used to determine eligibility, prescribe, authorize and pay for prosthetic devices and glasses, obtain estimates, allow direct purchase and obtain information on loaned devices.
Authorizing Statute(s):
US Code:
38 USC 3902
Name of Law: Assistance for providing automobile and adaptive equipment
US Code:
38 USC 3903
Name of Law: Limitations on assistance; special training courses
US Code:
38 USC 3904
Name of Law: Research and development
US Code:
38 USC 1701(6)
Name of Law: Definitions
US Code:
38 USC 3901
Name of Law: Definitions
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:
72 FR 152
08/08/2007
30-day Notice:
Federal Register Citation:
Citation Date:
72 FR 199
10/16/2007
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Claim, Authorization & Invoice for Prosthetic Items & Services
10-2914, 10-2421, 10-2520, Form Letter 10-90, 10-1394, 10-0103
VETERANS APPLICATION FOR ASSISTANCE In Acquiring Home Improvement and Structural Alterations
,
APPLICATION FOR ADAPTIVE EQUIPMENT MOTOR VEHICLE
,
PROSTHETIC AUTHORIZATION FOR ITEMS OR SERVICES
,
PROSTHETIC SERVICE CARD INVOICE
,
PRESCRIPTION AND AUTHORIZATION FOR EYEGLASSES
,
REQUEST TO SUBMIT ESTIMATE
ICR Summary 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
71,200
697,200
0
0
-626,000
0
Annual Time Burden (Hours)
5,738
48,522
0
0
-42,784
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:
10-1394 - Using FY06 and FY07 1st and 2nd quarter data, Prosthetics can better estimate the number of automobile adaptive claims filed on 10-1394. There has been no significant change in workload or procedure, but rather more accurate data collection over the years. 10-2421 - Since our last request, Prosthetics services have moved towards the goal of 100% purchase card use; however, we cannot mandate that all vendors accept purchase cards. Due to this, we anticipate a sharp decline in the use of 10-2421. 10-2914 - Since our last request, eyeglass consults have been standardized in the VAs Computerized Patient Record System. VA uses fee basis or contract providers to meet their eyeglass prescription needs. These fee basis/contract prescriptions must still be provided on 10-2914. 10-426 - Loan Follow-up Letter, is no longer used because the loan program has been discontinue.
Annual Cost to Federal Government:
$113,736
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
Uncollected
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Denise McLamb 202-565-8374 denise.mclamb@mail.va.gov
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:
11/01/2007
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