Community Residential Care (CRC) Program - Recordkeeping, Incident Reporting, Applications

OMB 2900-0491

This requirement states that Community Residential Care Facilities maintain a record for each Veteran which contains a copy of the plan of care, emergency notification procedures, and a copy of all signed agreements with the resident.

The latest form for Community Residential Care (CRC) Program - Recordkeeping, Incident Reporting, Applications expires 2021-04-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 10-387 MFH Application Form and Instruction
Form 10-2407 CRC Application Form and Instruction
30-day FRN_2900-0491_CRC Program-Recordkeeping Incident Reporting Applications_pub 12132024.pdf Supplementary Document
60-day FRN_2900-0491_Community Residential Care (CRC) Program - Recordkeeping, Incident Reporting, Applications_pub 10072024.pdf Supplementary Document
SSA_2900-0491_Community Residential Care (CRC) Program_updated Dec 2024.docx Supporting Statement A
MFH Application Form and Instruction
CRC Application Form and Instruction
CRC Inident Reporting
Community Residential Care Recordkeeping

All Historical Document Collections

202409-2900-003	Reinstatement with change of a previously approved collection	2024-12-13
202102-2900-019 Approved without change	Reinstatement without change of a previously approved collection	2021-10-29
201704-2900-009 Approved without change	Reinstatement with change of a previously approved collection	2018-02-15
198804-2900-002 Approved without change	New collection (Request for a new OMB Control Number)	1988-04-26