Information Collection

2900-AP83 Ecclesiastical Endorsing Organization

IC 224350 under ICR 201708-2900-034 · OMB 2900-0852.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-0379 2900-AP83 Ecclesiastical Endorsing Organization	Form and Instruction
10-0379 ECCLESIASTICAL ENDORSING ORGANIZATION VA 10-0379 (12-05v) by Forms in Word 10-25-16.doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	10-0379	ECCLESIASTICAL ENDORSING ORGANIZATION	VA 10-0379 (12-05v) by Forms in Word 10-25-16.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

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
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	38	38
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.