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Federal forms, ICRs, and supporting documents

Information Collection Request

Joint Application for Comprehensive Assistance and Support Services for Family Caregivers, VA Form 10-10CG

ICR 201105-2900-001 · OMB 2900-0768 · Historical Inactive

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
197562 Application for Comprehensive Assistance for Family Caregivers Program New
ICR Details
2900-0768 201105-2900-001
Historical Inactive
VA
Joint Application for Comprehensive Assistance and Support Services for Family Caregivers, VA Form 10-10CG
New collection (Request for a new OMB Control Number)   No
Emergency 05/03/2011
Preapproved 05/03/2011
Retrieve Notice of Action (NOA) 05/03/2011
VA is developing an online application. When then the online application is ready, VA will upload screen shots along with a request for a non-substantive change.
  Inventory as of this Action Requested Previously Approved
11/30/2011 6 Months From Approved
5,000 0 0
1,250 0 0
0 0 0
This form collects information from applicants for the Caregivers Program.
This is a legal requirement for rulemaking and the rule cannot go forward until the form is cleared. This high priority interim final rule must be published by May 3rd, and it involves an application for caregivers to apply for certain monetary benefits. VA's failure to collect this information would mean: a. Veterans and their primary and secondary family Caregivers would not be allowed to apply for this benefit as authorized by Public Law (P.L.) 111-163, Caregivers and Veterans Omnibus Health Services Act of 2010, specifically, title 1, section 101 through 104. b. The failure to apply for and receive these benefits would result in: a). negatively affecting financial resources for the Caregiver; b). reducing the quality of life and care for the Veteran; and c). potentially limiting the health care options for Caregivers.
PL: Pub.L. 111 - 163 1720G Name of Law: Caregivers and Veterans Omnibus Health Services Act of 2010
  
PL: Pub.L. 111 - 163 1720G Name of Law: Caregivers and Veterans Omnibus Health Services Act of 2010
2900-AN94 Final or interim final rulemaking
No
1
IC Title Form No. Form Name
Application for Comprehensive Assistance for Family Caregivers Program VA Form 10-10CG
  Total Request 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 5,000 0 5,000 0 0 0
Annual Time Burden (Hours) 1,250 0 1,250 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
This is a new collection. All burden hours are considered an increase.
$52,000
No
No
No
No
No
Uncollected
Denise McLamb 202-565-8374 [email protected]
  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.
05/03/2011