Information Collection

Application for Comprehensive Assistance for Family Caregivers Program

IC 197562 under ICR 201903-2900-033 · OMB 2900-0768.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0768 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 10-10CG Application for Comprehensive Assistance for Family Caregivers Program Form and Instruction
VA Form 10-10CG Application for Comprehensive Assistance for Family Care Caregivers Final.pdf www.va.gov/vaforms/medical/pdf/10-10CG.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Comprehensive Assistance for Family Caregivers Program	Agency IC Tracking Number:	2900-0768

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	VA Form 10-10CG	Application for Comprehensive Assistance for Family Caregivers Program	Caregivers Final.pdf	http://www.va.gov/vaforms/medical/pdf/10-10CG.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: âPatient Medical Records --VAâ (24VA19), âEnrollment and Eligibility Records --VAâ (147VA16), and âHealth Administration Center Civilian Health and Medical Program Records--VAâ (54VA17)	FR Citation: 69 FR 18428

Number of Respondents: 16,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	16,500	11,500	5,000
Annual IC Time Burden (Hours)	4,125	2,875	1,250
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.