Information Collection

CHAMPVA Benefits - Application, Claim, OHI, Potential Liability and Spina Bifida Benefits

IC 28466 under ICR 200107-2900-018 · OMB 2900-0219.

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Documents and Forms

Documents and forms in this information collection
Document Name	Document Type

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IC Title:

CHAMPVA Benefits - Application, Claim, OHI, Potential Liability and Spina Bifida Benefits

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	10-10D	Yes	Yes
Form	10-7959A	Yes	Yes
Form	10-7959C	Yes	Yes
Form	10-7959D	Yes	Yes

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 381,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 11 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	381,000	-24,000	405,000
Annual IC Time Burden (Hours)	63,000	-1,600	64,600
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.