Information Collection

Application for Comprehensive Assistance for Family Caregivers Program

IC 197562 under ICR 202412-2900-006 · OMB 2900-0768.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-10CG Application for Comprehensive Assistance for Family Caregivers Program	Form and Instruction
Form VA Form 10-10CG Application for the Program of Comprehensive Assistance for Family Caregivers Application for Comprehensive Assistance for Family Caregivers Program	Form and Instruction
VA Form 10-10CG Application for the Program of Comprehensive Assistance VA Form 10-10CG.pdf www.va.gov/vaforms/medical/pdf/10-10CG.pdf	Form and Instruction
VA Form 10-10CG Application for the Program of Comprehensive Assistance VA Form 10-10CG_rev Feb 2025.pdf www.va.gov/vaforms/medical/pdf/10-10CG.pdf	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Application for Comprehensive Assistance for Family Caregivers Program

Agency IC Tracking Number:

2900-0768

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 71

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	VA Form 10-10CG			http://www.va.gov/vaforms/medical/pdf/10-10CG.pdf	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: âPatient Medical Records --VAâ (24VA19), âEnrollment and Eligibility Records --VAâ (147VA16), and âHealth Administration Center Civilian Health and Medical Program Records--VAâ (54VA17)

FR Citation: 69 FR 18428

Number of Respondents: 140,671

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	140,671	30,000	110,671
Annual IC Time Burden (Hours)	35,168	7,500	27,668
Annual IC Cost Burden (Dollars)	0	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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