VHA Fraud, Waste and Abuse Complaint Form

VHA Fraud, Waste and Abuse Complaints (VA Form 10-390)

Documents and Forms

Document Name Document Type
Form 10-390 VHA Fraud, Waste and Abuse Complaint Form Form and Instruction
10-390 VHA Fraud, Waste and Abuse Complaint Form VA Form 10-390_conformant_Jun 2024.pdf Form and Instruction
10-390 VHA Fraud, Waste and Abuse Complaint Form VA Form 10-390_conformant_Jun 2024.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	VHA Fraud, Waste and Abuse Complaint Form	Agency IC Tracking Number:	2900-NEW

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10-390	VHA Fraud, Waste and Abuse Complaint Form	VA Form 10-390_conformant_Jun 2024.pdf		Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Executive Functions

Privacy Act System of Records
Title: 110VA17 - Compliance Record, Response, and Resolution of Reports of Persons Allegedly Involved in Compliance Violations --VA	FR Citation: 74 FR 41490

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	50	50
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.