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OMB Control No: 2900-0920	ICR Reference No: 202602-2900-012
Status: Received in OIRA	Previous ICR Reference No: 202303-2900-008
Agency/Subagency: VA	Agency Tracking No: VHA-2900-0920
Title: Copayment Exemption for Indian Veterans - Documentation of Indian or Urban Indian Status
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 09/10/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	3,000	0
Time Burden (Hours)	750	0
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Change Due to Agency Discretion
Annual Number of Responses	3,000	3,000
Annual Time Burden (Hours)	750	750
Annual Cost Burden (Dollars)	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: There is actually a decrease in the estimated annual respondents and burden hours based upon data since the last PRA clearance. (The ICR is displaying an "increase" in the burden hours because this is a reinstatement of the collection.)

Annual Cost to Federal Government: $72,717

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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