Information Collection

Appraisal of Applicant

IC 241295 under ICR 202001-2900-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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 FL 10-341(a) Appraisal of Applicant	Form and Instruction
FL 10-341(a) Appraisal of Applicant vha-FL-10-341a-fill.pdf	Form and Instruction

IC Title:

Appraisal of Applicant

Agency IC Tracking Number:

2900-0205

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	FL 10-341(a)	Appraisal of Applicant	vha-FL-10-341a-fill.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50,820

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	50,820	50,820
Annual IC Time Burden (Hours)	25,410	25,410
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.