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Application for Comprehensive Assistance for Family Caregivers Program
Program of Comprehensive Assistance for Family Caregivers (PCAFC) - VA Form 10-10CG
OMB: 2900-0768
IC ID: 197562
OMB.report
VA
OMB 2900-0768
ICR 202309-2900-005
IC 197562
( )
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.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.pdf
www.va.gov/vaforms/medical/pdf/10-10CG.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
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.pdf
http://www.va.gov/vaforms/medical/pdf/10-10CG.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
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:
110,671
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
75 %
Approved
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
110,671
0
47,895
0
0
62,776
Annual IC Time Burden (Hours)
27,668
0
11,974
0
0
15,694
Annual IC Cost Burden (Dollars)
0
0
0
0
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.