Application Requirements to Receive VA Dental Insurance Plan Benefits under 38 CFR 17.169

Documents and Forms

Document Name Document Type
VADIP_Fact_Sheet_v14.pdf Other-Fact Sheet

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application Requirements to Receive VA Dental Insurance Plan Benefits under 38 CFR 17.169	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 17.169

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Fact Sheet			VADIP_Fact_Sheet_v14.pdf		Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 283,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	283,500	283,500
Annual IC Time Burden (Hours)	38,350	38,350
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.