Information Collection

Application for Extended Care Services

IC 28899 under ICR 200801-2900-009 · OMB 2900-0629.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0629 can be found here:

Documents and Forms

Document Name Document Type
Form 10-10EC Application for Extended Care Services Form and Instruction
10-10EC Application for Extended Care Benefits 10-10EC-fill.pdf www.va.gov/vaforms Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Extended Care Services	Agency IC Tracking Number:	2900-0629

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

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	10-10EC	Application for Extended Care Benefits	10-10EC-fill.pdf	https://www.va.gov/vaforms	Yes	No	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,000	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	6,000	6,000
Annual IC Time Burden (Hours)	9,000	9,000
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.