CHAMPVA Application for Benefits

CHAMPVA Benefits - Application, Claim, Other Health Insurance, Potential Liability & Misc Expenses

OMB: 2900-0219

IC ID: 246417

Information Collection (IC) Details

View Information Collection (IC)

CHAMPVA Application for Benefits 2900-0219
 
No New
 
Required to Obtain or Retain Benefits
 
38 CFR 1.900 38 CFR 17.900 through 17.905

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form 10-10d CHAMPVA Application for Benefits vha-10-10d-fill_CHAMPVA_Application for Benefits.pdf http://www.gov/vaforms/Search_action.asp Yes No Fillable Printable

Health Health Care Services

 

53,775 0
   
Individuals or Households
 
   0 %

  Requested Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 53,775 0 53,775 0 0 0
Annual IC Time Burden (Hours) 8,963 0 8,963 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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