Information Collection

VCAP Appointment Certification Form

IC 269562 under ICR 202407-2900-010 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-381 VCAP Appointment Certification Form	Form
10-381 Appointment Certification Form VA Form 10-381_Sep 2024.pdf	Form
10-381 Appointment Certification Form VA Form 10-381_Sep 2024.pdf	Form

IC Title:

Agency IC Tracking Number:

2900-NEW

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	10-381	Appointment Certification Form	VA Form 10-381_Sep 2024.pdf		Yes	Yes	Fillable Fileable Signable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: 24VA19 "Patient Medical Record--VA"

FR Citation: 69 FR 18428

Number of Respondents: 290,528

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,776,864	3,776,864
Annual IC Time Burden (Hours)	125,895	125,895
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.