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Federal forms, ICRs, and supporting documents

Information Collection

Foreign Medical Program Application and Claim Cover Sheet

IC 28924 under ICR 202310-2900-003 · OMB 2900-0648.

Documents and Forms

Documents and forms in this information collection
Document NameDocument Type
Form 10-7959f-1
Foreign Medical Program Application and Claim Cover Sheet		 Form
10-7959f-1 Foreign Medical Program (FMP) Registration Form
VA Form 10-7959f-1.pdf 		Form
10-7959f-1 Foreign Medical Program (FMP) Registration Form
VA Form 10-7959f-1.pdf 		Form
10-7959f-2 Foreign Medical Program (FMP) Claim Cover Sheet
VA Form 10-7959f-2.pdf 		Form
10-7959f-2 Foreign Medical Program (FMP) Claim Cover Sheet
VA Form 10-7959f-2.pdf 		Form

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 10-7959f-1 Foreign Medical Program (FMP) Registration Form VA Form 10-7959f-1.pdf Yes No Fillable Printable
Form 10-7959f-2 Foreign Medical Program (FMP) Claim Cover Sheet VA Form 10-7959f-2.pdf Yes Yes Fillable Printable

Federal Enterprise Architecture Business Reference Module


table that charts list of burden
  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 21,580 0 0 0 0 21,580
Annual IC Time Burden (Hours) 3,763 0 0 0 0 3,763
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Documents for IC
table that charts IC Documents
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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.