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Federal forms, ICRs, and supporting documents

Information Collection Request

OUTLINE FOR OBTAINING INFORMATION AS TO SUITABILITY OF HOME OTHER THAN PATIENTS OWN

ICR 198210-2900-011 · OMB 2900-0082 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
174220 OUTLINE FOR OBTAINING INFORMATION AS TO SUITABILITY OF HOME OTHER THAN PATIENTS OWN Form Migrated
ICR Details
2900-0082 198210-2900-011
Historical Active 198201-2900-009
VA
OUTLINE FOR OBTAINING INFORMATION AS TO SUITABILITY OF HOME OTHER THAN PATIENTS OWN
No material or nonsubstantive change to a currently approved collection   No
Emergency 10/01/1982
Approved with change 10/01/1982
Retrieve Notice of Action (NOA) 10/01/1982
  Inventory as of this Action Requested Previously Approved
08/31/1984 08/31/1984 08/31/1984
3,400 0 3,400
567 0 1,500
0 0 0
PROVIDES AN OUTLINE OF INFORMATION REQUIRED TO BE COMPLETED BY A SOCIA WORKER UPON APPLICATION BY AN INDIVIDUAL TO PARTICIPATE AS A PROVIDER IN THE VA RESIDENTIAL CARE HOME PROGRAM. ASSESSMENT PROVIDES BASIS FO DECISION WHETHER TO APPROVE FOR PARTICIPATION IN PROGRAMS.
None
None
No
1
IC Title Form No. Form Name
OUTLINE FOR OBTAINING INFORMATION AS TO SUITABILITY OF HOME OTHER THAN PATIENTS OWN 10-2408
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 3,400 3,400 0 0 0 0
Annual Time Burden (Hours) 567 1,500 0 -933 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
10/01/1982