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Federal forms, ICRs, and supporting documents

OMB control number

Expanded Access to Non-VA Care Through the Mission Act: Veterans Community Care Program (VCCP)

OMB 2900-0823 · VA.

OMB 2900-0823

Section 101 of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 requires VA to implement the Veterans Community Care Program (VCCP) to furnish care in the community to covered Veterans through eligible entities and providers, under circumstances as further prescribed in the MISSION Act. VA currently collects information that will be required to implement the Veterans Community Care Program under the Veterans Choice Program, through an OMB approved collection 2900-0823. OMB collection 2900-0823 includes VA Form 10-10143, Election to Receive Authorized Non-VA Care and Selection of Provider for the Veterans Choice Program; VA Form 10-10143a, Health-Care Plan Information for the Veterans Choice Program; VA Form 10-10143b, Submission of Medical Record Information under the Veterans Choice Program; VA Form 10-10143c, Submission of Information on Credentials and Licenses by Eligible Entities and Providers; VA Form 10-10143e, Secondary Authorization Request for VA Community Care; and VA Form 10-10143f, Community Care Document Cover Sheet. A new form is being added to this collection: VA Form 10-10143g, Non-VA Hospital Emergency Notification.

The latest form for Expanded Access to Non-VA Care Through the Mission Act: Veterans Community Care Program (VCCP) expires 2020-10-31 and is listed under ICR 202005-2900-018.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 10-10143g Non-VA Hospital Emergency NotificationForm
Form 10-10143f Community Care Document Cover SheetForm and Instruction
Form 10-10143e SAR for VA Community CareForm
Form 10-10143a Veterans Community Care Health Insurance CertificationForm and Instruction
30-day FRN_2900-0823_Expanded Access to Non-VA Care_VCCP_AQ46_published 12022020.pdf Supplementary Document
60-day FRN_2900-0823_Expanded Access to Non-VA Care_VCCP_AQ46_published 08142020.pdf Supplementary Document
2900-0823_Expanded Access to Non-VA Care - VCCP_Supp Statement A_updated Feb 2021.docxSupporting Statement A
10-10143g: Non-VA Hospital Emergency Notification Form
10-10143g: Non-VA Hospital Emergency Notification Form
10-10143f - Community Care Document Cover Sheet Form and Instruction
10-10143f - Community Care Document Cover Sheet Form and Instruction
10-10143e Secondary Authorization Request (SAR) for VA Community Care Form
10-10143e Secondary Authorization Request (SAR) for VA Community Care Form
10-10143c Submission of Information on Credentials and Licenses by Eligible Entities and Providers Information collection
10-10143b Submission of Medical Record Information under the Veterans Community Care Program Information collection
10-10143a Veterans Community Care Health Insurance Certification Form and Instruction
10-10143a Veterans Community Care Health Insurance Certification Form and Instruction
10-10143 Election to Receive Authorized Non-VA Care and Selection of Provider for the Veterans Community Care Program Other-Script

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202008-2900-001 Reinstatement without change of a previously approved collection 2021-03-01 Withdrawn
202005-2900-019 Extension without change of a currently approved collection 2020-07-15 Withdrawn and continue
202005-2900-018 Revision of a currently approved collection 2020-05-28 Approved without change
201905-2900-007 Revision of a currently approved collection 2020-03-31 Approved without change
201604-2900-018 Revision of a currently approved collection 2017-01-22 Approved without change
201502-2900-004 Extension without change of a currently approved collection 2015-05-28 Approved without change
201410-2900-012 New collection (Request for a new OMB Control Number) 2014-10-27 Approved with change

OMB Details

10-10143 Election to Receive Authorized Non-VA Care and Selection of Provider for the Veterans Community Care Program

Federal Enterprise Architecture: Health - Health Care Services