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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.