Information Collection

Application for Health Professions Trainees - VA Form 2850D

IC 235698 under ICR 201904-2900-002 · OMB 2900-0205.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0205 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-2850D Application for Health Professions Trainees - VA Form 2850D	Form and Instruction
10-2850D VA Form 10-2850D - Application for Health Professions Tr VHA Form 10-2850D_For Renewal Approval_2019.pdf	Form and Instruction

IC Title:

Application for Health Professions Trainees - VA Form 2850D

Agency IC Tracking Number:

2900-NEW

Is this a Common Form? Yes

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	10-2850D	VA Form 10-2850D - Application for Health Professions Trainees	VHA Form 10-2850D_For Renewal Approval_2019.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 121,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	121,000	121,000
Annual IC Time Burden (Hours)	60,500	60,500
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.