View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 2900-0648	ICR Reference No: 201702-2900-011
Status: Historical Active	Previous ICR Reference No: 201507-2900-005
Agency/Subagency: VA	Agency Tracking No: 2900-0648
Title: Foreign Medical Program Application and Claim Cover Sheet
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/31/2018
	Date Received in OIRA: 10/11/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2019	03/31/2019	03/31/2019
Responses	21,580	0	21,580
Time Burden (Hours)	3,763	0	3,763
Cost Burden (Dollars)	0	0	0

Annual Cost to Federal Government: $34,815

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? Uncollected

Agency Contact: Cynthia Harvey - Pryor 202 461-5870 cynthia.harvey-pryor@va.gov

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