Information Collection

State Homes Program Application for Veterans Care Medical Certification

IC 237053 under ICR 201906-2900-007 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
Form 10-10SH State Homes Program Application for Veterans Care Medical Certification Form and Instruction
10-10SH State Homes Program Application for Veterans Care Medica VA Form 10-10SH_revised 2020.pdf www.va.gov/vaforms/ Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Homes Program Application for Veterans Care Medical Certification	Agency IC Tracking Number:	2900-0160

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 51 38 CFR 52

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10-10SH	State Homes Program Application for Veterans Care Medical Certification	VA Form 10-10SH_revised 2020.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: 11,406	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	11,406	11,406
Annual IC Time Burden (Hours)	3,802	3,802
Annual IC Cost Burden (Dollars)	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.