View Information Collection Request (ICR) Package

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: 2900-0160	ICR Reference No: 199508-2900-006
Status: Historical Active	Previous ICR Reference No: 199103-2900-008
Agency/Subagency: VA	Agency Tracking No:
Title: Non-Federal Health Care Provider and Reimbursement Form
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/20/1995
	Date Received in OIRA: 08/15/1995
Terms of Clearance: Because VA allowed this information collection to expire in 3/94, OMB expeditiously approves this collection for a limited time period through 9/96. However, prior to the next submission for OMB review, VA should justify each data element collected on VA Form 10-1170 (i.e. required by statute, regulation, etc.). In particular, OMB requests a justification of the burdensome staffing data included in question 14.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/1996	09/30/1996
Responses	1,480	0	0
Time Burden (Hours)	315	0	0
Cost Burden (Dollars)	0	0	0

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