Information Collection

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

IC 202798 under ICR 201611-2900-004 · OMB 2900-0789.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
VADIP_Fact_Sheet_v14.pdf	Other-Fact Sheet

IC Title:

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:

table that charts list of 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 %

table that charts list of burden
	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

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.