View Information Collection Request (ICR) Package
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View Information Collection (IC) List
View Supporting Statement and Other Documents
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:
2900-0080
ICR Reference No:
201310-2900-001
Status:
Historical Active
Previous ICR Reference No:
201009-2900-007
Agency/Subagency:
VA
Agency Tracking No:
2900-0080
Title:
Funeral Arrangements
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
10/24/2014
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/13/2014
Terms of Clearance:
Approved consistent with the following terms of clearance: OMB encourages VA to continue Departmental efforts aimed at providing respondents with a fully electronic version of associated forms that may be completed and submitted electronically and that include the recognition of electronic signatures.
Inventory as of this Action
Requested
Previously Approved
Expiration Date
10/31/2017
36 Months From Approved
10/31/2014
Responses
22,213
0
464,155
Time Burden (Hours)
3,702
0
33,079
Cost Burden (Dollars)
0
0
0
Abstract:
VA Form 10-2065 is part of the Decedent Affairs Package. The form is completed during the interview with relatives of the deceased, and identifies the funeral home to which the remains are to be released. The family signs the form designating that it reflects their wishes. It is used as a control document when VA is requested to arrange for the transportation of the deceased from the place of death to the place of burial, and/or when burial is requested in a National Cemetery.
Authorizing Statute(s):
US Code:
38 USC 1728
Name of Law: Reimbursement of certain medical expenses
US Code:
38 USC 111
Name of Law: Payments or allowances for beneficiary travel
US Code:
38 USC 1703
Name of Law: Contracts for hospital care and medical services in non-Department facilities
US Code:
38 USC 1725
Name of Law: Reimbursement for emergency treatment
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:
79 FR 3275
01/17/2014
30-day Notice:
Federal Register Citation:
Citation Date:
79 FR 25191
05/02/2014
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 for Payment of Cost of Unauthorized Medical Services; Funeral Arrangements; Authority and Invoice for Travel by Ambulance or Other Hired Vehicle; Authorization and Invoice...
10-583, 10-7078, 10-2065, 10-2511
CLAIM FOR PAYMENT OF COST OF UNAUTHORIZED MEDICAL SERVICES
,
FUNERAL ARRANGEMENTS
,
AUTHORITY AND INVOICE FOR TRAVEL BY AMBULANCE OR OTHER HIRED VEHICLE
,
AUTHORIZATION AND INVOICE FOR MEDICAL AND HOSPITAL SERVICES
Funeral Arrangements Request Form
10-2065
FUNERAL ARRANGEMENTS
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
22,213
464,155
0
-441,942
0
0
Annual Time Burden (Hours)
3,702
33,079
0
-29,377
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:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
VA Forms 10-2511; 10-583; and Form 10-7078 are forms that are not completed by respondents. They are internal VA forms, therefore burden hours are no longer applicable.
Annual Cost to Federal Government:
$60,160
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]?
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?
Uncollected
Agency Contact:
Crystal Rennie 202 632-7492 crystal.rennie@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:
05/13/2014
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