Information Collection

Funeral Arrangements, Application For Medical Benefits, Insurance Information And Fianancial Worksheet

IC 146989 under ICR 199209-2900-006 · OMB 2900-0091.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0091 can be found here:

Documents and Forms

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Information Collection (IC) Details

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IC Title:	FUNERAL ARRANGEMENTS, APPLICATION FOR MEDICAL BENEFITS, INSURANCE INFORMATION AND FIANANCIAL WORKSHEET	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?
Form	VA 10-2065	No	No
Form	VA 10-10	No	No
Form	VA 10-10I	No	No
Form	VA 10-10F	No	No

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 7,200,850	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	7,200,850	7,200,850
Annual IC Time Burden (Hours)	3,212,734	3,212,734
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded

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