Information Collection

VA Kids Care

IC 275428 under ICR 202503-2900-010 · OMB 2900-0876.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0876 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2900-0876 VA Kids 2900-0876 VA Kids Care VA Kids Care	Form and Instruction
2900-0876 VA Kids 2900-0876 VA Kids Care VA Kids Care Wireframe.docx	Form and Instruction
A-11 Fast-Track Clearance Request Template_VA Kids Care.docx VA Kids Care	IC Document
Measurement_Approval_Memo_OMB Clearance 2900-0876_VA Kids Care Signed.pdf Signed approval	IC Document

IC Title:

VA Kids Care

Agency IC Tracking Number:

2900-0876 VA Kids Care

IC Status: New

Obligation to Respond: Voluntary

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	2900-0876 VA Kids Care				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 10,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	667	667
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
VA Kids Care		05/22/2025
Signed approval		05/27/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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