Information Collection

State Home Report and Statement of Federal Aid Claimed

IC 237051 under ICR 202410-2900-027 · OMB 2900-0160.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-5588 State Home Report and Statement of Federal Aid Claimed	Form
10-5588 State Home Report and Statement of Federal Aid Claimed VA Form 10-5588.pdf www.va.gov/vaforms/	Form
10-5588 State Home Report and Statement of Federal Aid Claimed VA Form 10-5588.pdf www.va.gov/vaforms/	Form

IC Title:

Agency IC Tracking Number:

2900-0160

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 52 38 CFR 51

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	10-5588	State Home Report and Statement of Federal Aid Claimed	VA Form 10-5588.pdf	http://www.va.gov/vaforms/	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 139

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,668	1,668
Annual IC Time Burden (Hours)	834	834
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.