Information Collection

Application for Assistance for Hiring and Retaining Nurses at State Homes

IC 181239 under ICR 200707-2900-037 · OMB 2900-0709.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0709 can be found here:

Documents and Forms

Document Name Document Type
Form 10-0430 Application for Assistance for Hiring and Retaining Nurses at State Homes Form
10-0430 APPLICATION FOR ASSISTANCE FOR HIRING AND RETAINING NURS 10-0430-fill.pdf www.va.gov/vaforms Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Assistance for Hiring and Retaining Nurses at State Homes	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	10-0430	APPLICATION FOR ASSISTANCE FOR HIRING AND RETAINING NURSES AT STATE HOMES	10-0430-fill.pdf	http://www.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 67	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	67	67
Annual IC Time Burden (Hours)	134	134
Annual IC Cost Burden (Dollars)	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.