Information Collection

Residential Care Home Program Sponsor Application

IC 28869 under ICR 201303-2900-003 · OMB 2900-0616.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0616 can be found here:

Documents and Forms

Document Name Document Type
Form VA Form 10-2407 Residential Care Home Program Sponsor Application Form
VA Form 10-2407 Residential Care Home Program_Sponsor Application VA Form 10-2407_fill.pdf vaww.va.gov/vaforms/ Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Residential Care Home Program Sponsor Application	Agency IC Tracking Number:	2900-0616

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	VA Form 10-2407	Residential Care Home Program_Sponsor Application	VA Form 10-2407_fill.pdf	http://vaww.va.gov/vaforms/	Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

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

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	500	-500	1,000
Annual IC Time Burden (Hours)	42	-83	125
Annual IC Cost Burden (Dollars)	0	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.