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State Homes Program Application for Veterans Care Medical Certification
State Home Programs for Veterans (VA Forms 10-5588, 10-5588A, 10-10SH) -- AR61
OMB: 2900-0160
IC ID: 237053
OMB.report
VA
OMB 2900-0160
ICR 202410-2900-027
IC 237053
( )
Documents and Forms
Document Name
Document Type
Form 10-10SH
State Homes Program Application for Veterans Care Medical Certification
Form and Instruction
10-10SH State Homes Program Application for Veterans Care Medica
VA Form 10-10SH.pdf
www.va.gov/vaforms/
Form and Instruction
10-10SH Online 10-10SH - Application for State Home Care
Online 10-10SH_Screenshots_2023.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
State Homes Program Application for Veterans Care Medical Certification
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 51
38 CFR 52
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
10-10SH
State Homes Program Application for Veterans Care Medical Certification
VA Form 10-10SH.pdf
http://www.va.gov/vaforms/
Yes
Yes
Fillable Fileable
Form and Instruction
10-10SH
Online 10-10SH - Application for State Home Care
Online 10-10SH_Screenshots_2023.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
11,406
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
11,406
0
0
0
0
11,406
Annual IC Time Burden (Hours)
3,802
0
0
0
0
3,802
Annual IC Cost Burden (Dollars)
0
0
0
0
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.