Camp Lejeune Family Member Program - Reimbursement of Certain Medical Expenses

Forms and Documents

Document Name	Status
Form 10-10068c Camp Lejeune Family Member Program - Information Update Form Form and Instruction	Modified
Form 10-10068b Camp Lejeune Family Member Program - Treating Physician Report Form and Instruction	Modified
Form 10-10068a Camp Lejeune Family Member Program - Claim Form Form and Instruction	Modified
Form 10-10068 Camp Lejeune Family Member Program - Application Form and Instruction	Modified
30-day FRN_2900-0822_Camp Lejeune Family Member Program_pub 08012025.pdf Supplementary Document	2025-08-01
60-day FRN_2900-0822_Camp Lejeune Family Member Program_pub 05292025.pdf Supplementary Document	2025-06-09
SSA_2900-0822_Camp Lejeune Family Member Prog - Reimb of Medical Exp _updated Aug 2025.docx Supporting Statement A	2025-08-01

IC Document Collections

IC ID	Document Title	Status
210897	Camp Lejeune Family Member Program - Information Update Form Form and Instruction	Modified
210896	Camp Lejeune Family Member Program - Treating Physician Report Form and Instruction	Modified
210895	Camp Lejeune Family Member Program - Claim Form Form and Instruction	Modified
210894	Camp Lejeune Family Member Program - Application Form and Instruction	Modified

ICR Details

OMB Control No: 2900-0822	ICR Reference No: 202504-2900-009
Status: Received in OIRA	Previous ICR Reference No: 202112-2900-006
Agency/Subagency: VA	Agency Tracking No: VHA-2900-0822
Title: Camp Lejeune Family Member Program - Reimbursement of Certain Medical Expenses
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/01/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	08/31/2025
Responses	23,349	21,720
Time Burden (Hours)	6,246	5,838
Cost Burden (Dollars)	0	0

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Abstract: Under 38 U.S.C. 1787, VA is required to furnish hospital care and medical services to the family members of certain veterans who were stationed at Camp Lejeune between 1953 and 1987. In order to furnish such care, VA must collect necessary information from the family members to ensure that they meet the requirements of the law. The specific hospital care and medical services that VA must provide are for a number of illnesses and conditions connected to exposure to contaminated drinking water while at Camp Lejeune. VA will furnish Camp Lejeune family members with hospital care and medical services for 15 illnesses and conditions that are life threatening and require immediate medical intervention. The forms in this collection will be used to determine eligibility and reimbursement for this medical care. Some minor changes to the wording in VA Form 10-10068b have been made to clarify the information being collected from the treating physician. Also, VA Form 10-10068b may now be used up to two times annually per patient, and there is an associated increase in the estimated burden hours.

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Authorizing Statute(s): US Code: 38 USC 1787 Name of Law: Health care of family members of veterans stationed at Camp Lejeune, North Carolina
  

Citations for New Statutory Requirements: US Code: 38 USC 1787 Name of Law: Health care of family members of veterans stationed at Camp Lejeune, North Carolina

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 22832	05/29/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 36286	08/01/2025
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Camp Lejeune Family Member Program - Application	10-10068	Camp Lejeune Family Member Program - Application
Camp Lejeune Family Member Program - Claim Form	10-10068a	Camp Lejeune Family Member Program - Claim Form
Camp Lejeune Family Member Program - Information Update Form	10-10068c	Camp Lejeune Family Member Program - Information Update Form
Camp Lejeune Family Member Program - Treating Physician Report	10-10068b	Camp Lejeune Family Member Program - Treating Physician Report

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ICR Summary of Burden

	Total Request	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	23,349	21,720	0	1,629	0	0
Annual Time Burden (Hours)	6,246	5,838	0	408	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: No

Burden Reduction Due to:

Short Statement: The burden hours have increased due to an increase in the use of VA Form 10-10068b from once annually to two times per year.

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Annual Cost to Federal Government: $194,562

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

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Common Form ICR:  No

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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: 08/01/2025

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