Information Collection

VHA Fraud, Waste and Abuse Complaint Form

IC 268544 under ICR 202405-2900-006 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

2900-NEW

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

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 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 %

table that charts list of burden
	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

table that charts IC Documents
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.