Title 38, Parts 51 and 52, State Home Program

Title 38, Parts 51 and 52, State Home Programs

OMB: 2900-0160

IC ID: 28394

Information Collection (IC) Details

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Title 38, Parts 51 and 52, State Home Program 2900-0160
 
No Modified
 
Required to Obtain or Retain Benefits
 
38 CFR 51 38 CFR 52

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 10-0143 Department of Veterans Affairs Certification Regarding Drug-Free Workplace Requirements for Grantees Other Than Individuals 2900-0160 VA Form 10-0143.pdf http://www.va.gov/vaforms/ Yes No Fillable Printable
Form 10-0143A Statement of Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973 2900-0160 VA Form 10-0143A.pdf http://www.va.gov/vaforms/ Yes No Fillable Printable
Form 10-0144 Certification Regarding Lobbying 2900-0160 VA Form 10-0144.pdf http://www.va.gov/vaforms/ Yes No Fillable Printable
Form 10-0144A Statement of Assurance of Compliance with Equal Opportunity Laws 2900-0160 VA Form 10-0144A.pdf http://www.va.gov/vaforms/ Yes No Fillable Printable
Form 10-10SH State Homes Program Application for Veterans Care Medical Certification 10-10SH-fill.pdf http://www.va.gov/vaforms/ Yes No Fillable Printable
Form 10-5588 State Home report and Statement of Federal Aid Claimed 10-5588-fill.pdf http://www.va.gov/vaforms/ Yes No Fillable Printable
Form 10-0460 Request for Prescription Drugs from an Eligible Veteran in a State Home 10-0460-fill.pdf http://www.va.gov/vaforms/ Yes No Fillable Printable
Form VA Form 10-3567 State Home Inspection Staffing Profile 10-3567-fill.pdf http://www.va.gov/vaforms/ Yes No Fillable Printable

Health Health Care Services

 

45,318 0
   
State, Local, and Tribal Governments
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 47,838 0 0 180 0 47,658
Annual IC Time Burden (Hours) 15,550 0 0 15 0 15,535
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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