Information Collection

Request for Prescription Drugs from an Eligible Veteran in a State Home

IC 236792 under ICR 201906-2900-005 · OMB 2900-0160.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0160 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-0460 Request for Prescription Drugs from an Eligible Veteran in a State Home	Form
10-0460 Request for Prescription Drugs from an Eligible Veteran 10-0460-fill_Needs New OMB No and Expir Date.pdf www.va.gov/vaforms/	Form

IC Title:

Request for Prescription Drugs from an Eligible Veteran in a State Home

Agency IC Tracking Number:

2900-NEW

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 51

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	10-0460	Request for Prescription Drugs from an Eligible Veteran in a State Home	10-0460-fill_Needs New OMB No and Expir Date.pdf	http://www.va.gov/vaforms/	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 11,000

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	11,000	11,000
Annual IC Time Burden (Hours)	5,500	5,500
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.