Information Collection

Application Requirements to Receive VA Dental Insurance Plan Benefits under 38 CFR 17.169; RIN 2900-AN99

IC 202798 under ICR 201301-2900-002 · OMB 2900-0789.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0789 can be found here:

Documents and Forms

Document Name Document Type
VADIP_Fact_Sheet_v14.pdf Other-Fact Sheet

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application Requirements to Receive VA Dental Insurance Plan Benefits under 38 CFR 17.169; RIN 2900-AN99	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 17.169

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Fact Sheet			VADIP_Fact_Sheet_v14.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 283,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	283,500	283,500
Annual IC Time Burden (Hours)	38,350	38,350
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.