Information Collection

Claim Cover Sheet for Foreign Medical Program

IC 28924 under ICR 200608-2900-008 · OMB 2900-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0648 can be found here:

Documents and Forms

Document Name Document Type
Form 10-7959f-2 Claim Cover Sheet for Foreign Medical Program Form
10-7959f-1 Foreign Medical Program (FMP) Registration Form 2900-0648 VA Form 10-7959f-1.pdf www.va.gov/hac/forms/forms.asp. AND www.va.gov/vaforms/ Form
10-7959f-2 Claim Cover Sheet - Foreign Medical Program (FMP) 2900-0648 VA Form 10-7959f-2.pdf www.va.gov/hac/forms/forms.asp. AND www.va.gov/vaforms/ Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Claim Cover Sheet for Foreign Medical Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 17.35 38 CFR 17.125(d)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	10-7959f-2	Claim Cover Sheet - Foreign Medical Program (FMP)	2900-0648 VA Form 10-7959f-2.pdf	http://www.va.gov/hac/forms/forms.asp. AND http://www.va.gov/vaforms/	Yes	No	Fillable Printable
Form	10-7959f-1	Foreign Medical Program (FMP) Registration Form	2900-0648 VA Form 10-7959f-1.pdf	http://www.va.gov/hac/forms/forms.asp. AND http://www.va.gov/vaforms/	Yes	No	Fillable Printable

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 3,320	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	21,580	1,660	19,920
Annual IC Time Burden (Hours)	3,762	110	3,652
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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