View Information Collection Request (ICR) Package

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View ICR - OIRA Conclusion

OMB Control No: 2900-0219	ICR Reference No: 202407-2900-007
Status: Active	Previous ICR Reference No: 202104-2900-006
Agency/Subagency: VA	Agency Tracking No: 2900-0219
Title: CHAMPVA Benefits - Application, Claim, Other Health Insurance, Potential Liability & Misc Expenses
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: 12/03/2024
	Date Received in OIRA: 10/30/2024
Terms of Clearance: OMB is approving this information collection request for a period of three years during which time the agency will request approval to extend or revise the collection if the agency seeks to continue the information collection activity beyond the period approved under this action.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2027	36 Months From Approved	12/31/2024
Responses	200,056	0	180,142
Time Burden (Hours)	37,867	0	34,548
Cost Burden (Dollars)	0	0	0

Authorizing Statute(s): US Code: 38 USC Section 1781 Name of Law: Medical care for survivors and dependents of certain veterans
   EO: EO 9397 Name/Subject of EO: Number System for Federal Accounts Relating to Individual Persons
   US Code: 38 USC Section 501 Name of Law: Rules and regulations
   US Code: 42 USC Section 2651 Name of Law: Recovery by United States
   US Code: 10 USC Section 1079 Name of Law: Contracts for medical care for spouses and children: plans
   US Code: 10 USC Section 1086 Name of Law: Contracts for health benefits for certain members, former members, and their dependents
   US Code: 42 USC Section 2652 Name of Law: Regulations
   US Code: 42 USC Section 2653 Name of Law: Limitation or repeal of other provisions for recovery of hospital and medical care costs

Citations for New Statutory Requirements: None

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	200,056	180,142	19,914
Annual Time Burden (Hours)	37,867	34,548	3,319
Annual Cost Burden (Dollars)	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: The increase in responses and burden hours takes into account program data showing an increase in CHAMPVA enrollment and the expected increase in claim submissions, OHI forms, appeals, and clinical reviews.

Annual Cost to Federal Government: $748,336

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

Agency Contact: Frances O'Donnell 703 405-2449 fran.odonnell@cathexiscorp.com

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