Information Collection

Regulation on Application for Fisher Houses and Other Temporary Lodging

IC 28902 under ICR 201706-2900-005 · OMB 2900-0630.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-0408A Regulation on Application for Fisher Houses and Other Temporary Lodging	Form and Instruction
10-0408A Temporary Housing Application 10-0408A.pdf vaww.va.gov/vaforms/medical/pdf/vha-10-0408A-fill.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

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	10-0408A	Temporary Housing Application	10-0408A.pdf	http://vaww.va.gov/vaforms/medical/pdf/vha-10-0408A-fill.pdf	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250,000

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 Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	500,000	-500,000	500,000	500,000
Annual IC Time Burden (Hours)	83,333	-83,333	83,333	83,333
Annual IC Cost Burden (Dollars)	0	-1,999,992	1,999,992	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.