Information Collection Request

EXPANDED ACCESS TO NON-VA CARE THROUGH THE VETERANS CHOICE PROGRAM, OMB 2900-AP24

ICR 201410-2900-012 · OMB 2900-0823 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 10-10143a 10-10143a Health-Care Plan Information for the Veterans Choice Program Form and Instruction New Available
Form 10-10143 10-10143 Election to Receive Authorized Non-VA Care and Selection of Provider for the Veterans Choice Program Form and Instruction New Available
Supporting Statements - v14 - Updated Estimates.docx Supporting Statement A Uploaded 2014-11-03 Available
Emergency Clearance Request - v2 - KLP Edits - 102714.docx Supplementary Document Uploaded 2014-10-27 Available

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
05/31/2015 6 Months From Approved
11,860,189 0 0
753,846 0 0
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 11,860,189 0 0 11,860,189 0 0
Annual Time Burden (Hours) 753,846 0 0 753,846 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
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