Information Collection

Camp Lejeune Family Member Program - Claim Form

IC 210895 under ICR 202504-2900-009 · OMB 2900-0822.

Documents and Forms

Document Name Document Type
Form 10-10068a Camp Lejeune Family Member Program - Claim Form Form and Instruction
Form 10-10068a Camp Lejeune Family Member Program - Claim Form Camp Lejeune Family Member Program - Claim Form Form and Instruction
10-10068a Camp Lejeune Family Member Program - Claim Form VA Form_10-10068a_rev May 2025.pdf Form and Instruction
10-10068a Camp Lejeune Family Member Program - Claim Form VA Form_10-10068a_rev May 2025.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Camp Lejeune Family Member Program - Claim Form	Agency IC Tracking Number:	2900-0822

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10-10068a	Camp Lejeune Family Member Program - Claim Form	VA Form_10-10068a_rev May 2025.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,629	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	17,919	17,919
Annual IC Time Burden (Hours)	4,480	4,480
Annual IC Cost Burden (Dollars)	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.

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