View Information Collection Request (ICR) Package
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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:
2900-0798
ICR Reference No:
202505-2900-003
Status:
Active
Previous ICR Reference No:
202402-2900-022
Agency/Subagency:
VA
Agency Tracking No:
2900-0798
Title:
Veteran/Beneficiary Claim for Reimbursement of Travel Expenses (VA Form 10-3542 and BTSSS)
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:
05/28/2025
Retrieve Notice of Action (NOA)
Date Received in OIRA:
05/22/2025
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
11/30/2027
11/30/2027
11/30/2027
Responses
7,300,000
0
7,300,000
Time Burden (Hours)
1,216,667
0
1,216,667
Cost Burden (Dollars)
0
0
0
Abstract:
Pursuant to 38 U.S.C. 111 and 38 C.F.R. Part 70, Subpart A, the Veterans Health Administration (VHA) Beneficiary Travel (BT) Program provides payments for authorized travel expenses to help Veterans and other beneficiaries obtain care or services from VHA and VA authorized non-VA providers in the community. VHA must administer payments according to statutory mandates, including the Payment Integrity Information Act of 2019 (PIIA) (Public Law 116-117). In compliance with the PIIA and other program requirements, VHA must gather certain information to determine whether BT eligibility and other criteria for approval have been met, and the amount of payment or reimbursement that is authorized under the BT program. Claimants may include Veterans and other BT beneficiaries, and entities or individuals who provided or paid for travel. Claimants may apply for BT reimbursement orally or in writing through VA Form 10-3542 or the Beneficiary Travel Self Service System (BTSSS). This standard collection of information is necessary to enable VHA to provide this benefit and appropriately ensure that funds are being paid to the correct claimant. VA Form 10-3542 has been revised to add intake fields for VHA use only. In the upper right area on page 1, two fields have been added for “Facility ID” and “Claim Received Date.” There are no changes to the estimated numbers of respondents or burden hours
Authorizing Statute(s):
US Code:
38 USC Section 111
Name of Law: Payments or allowances for beneficiary travel
PL:
Pub.L. 116 - 117 1-3
Name of Law: Payment Integrity Information Act
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:
89 FR 15928
03/05/2024
30-day Notice:
Federal Register Citation:
Citation Date:
89 FR 76623
09/18/2024
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Veteran/Beneficiary Claim for Reimbursement of Travel Expenses
VA Form 10-3542
Veteran/Beneficiary Claim for Reimbursement of Travel Expenses
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
7,300,000
7,300,000
0
0
0
0
Annual Time Burden (Hours)
1,216,667
1,216,667
0
0
0
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:
Annual Cost to Federal Government:
$29,216,875
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
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:
05/22/2025
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