Information Collection

Spouse Additional Income

IC 249240 under ICR 202010-2900-006 · OMB 2900-0867.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0867 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-302a Spouse Additional Income	Form and Instruction
10-302a Spouse Additional Income VA Form 10-302a.pdf	Form and Instruction

IC Title:

Spouse Additional Income

Agency IC Tracking Number:

2900-0867

Is this a Common Form? No

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	10-302a	Spouse Additional Income	VA Form 10-302a.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,680

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	5,680	5,680
Annual IC Time Burden (Hours)	1,420	1,420
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.