Information Collection

Application for Comprehensive Assistance for Family Caregivers Program

IC 197562 under ICR 201105-2900-003 · OMB 2900-0768.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0768 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-10CG Application for Comprehensive Assistance for Family Caregivers Program	Form and Instruction
VA Form 10-10CG Application for Comprehensive Assistance for Family Care Application for Caregiver Act 17_2011_04_28D.PDF To be determined	Form and Instruction

IC Title:

Application for Comprehensive Assistance for Family Caregivers Program

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Mandatory

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 and Instruction	VA Form 10-10CG	Application for Comprehensive Assistance for Family Caregivers Program	Application for Caregiver Act 17_2011_04_28D.PDF	To be determined	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	1,250	1,250
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.