Information Collection

MFH Application

IC 271297 under ICR 202409-2900-003 · OMB 2900-0491.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-387 MFH Application	Form and Instruction
Form 10-387 Medical Foster Home Caregiver Application MFH Application	Form and Instruction
10-387 Medical Foster Home Caregiver Application VA Form 10-387_Nov 2024.pdf	Form and Instruction
10-387 Medical Foster Home Caregiver Application VA Form 10-387_Nov 2024.pdf	Form and Instruction

IC Title:

MFH Application

Agency IC Tracking Number:

2900-0491

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 and Instruction	10-387				Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Community Residential Care and Medical Foster Home Programs-VA (142VA10)

FR Citation: 88 FR 48958

Number of Respondents: 1,000

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	1,000	1,000
Annual IC Time Burden (Hours)	167	167
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.

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