Application for Comprehensive Assistance for Family Caregivers Program

Program of Comprehensive Assistance for Family Caregivers - Improvements and Amendments Under the VA MISSION Act of 2018 (VA Form 10-10CG)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0768 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 10-10CG Application for Comprehensive Assistance for Family Caregivers Program Form and Instruction
VA Form 10-10CG Application for the Program of Comprehensive Assistance VA Form 10-10CG_revised Feb 2021.pdf www.va.gov/vaforms/medical/pdf/10-10CG.pdf Form and Instruction
VA Form 10-10CG Application for the Program of Comprehensive Assistance VA Form 10-10CG_revised Feb 2021.pdf www.va.gov/vaforms/medical/pdf/10-10CG.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Application for Comprehensive Assistance for Family Caregivers Program	Agency IC Tracking Number:	2900-0768

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 71

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	VA Form 10-10CG	Application for the Program of Comprehensive Assistance for Family Caregivers	VA Form 10-10CG_revised Feb 2021.pdf	http://www.va.gov/vaforms/medical/pdf/10-10CG.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: “Patient Medical Records --VA” (24VA19), “Enrollment and Eligibility Records --VA” (147VA16), and “Health Administration Center Civilian Health and Medical Program Records--VA” (54VA17)	FR Citation: 69 FR 18428

Number of Respondents: 62,776	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

	Approved	Previously Approved
Annual Number of Responses for this IC	62,776	62,776
Annual IC Time Burden (Hours)	15,694	15,694
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.