OMB.report

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 201408-2900-016 · OMB 2900-0768 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form VA Form 10-10CG Application for Comprehensive Assistance for Family Caregivers Program Form and Instruction Modified Available
201408-2900-016_VA Caregivers Application Form Justification A 2900-0768_Final.docx Supporting Statement A Uploaded 2015-04-10 Available
IC Document Collections
IC IDCollectionTypeStatusForm
197562 Application for Comprehensive Assistance for Family Caregivers Program Form and Instruction Modified
ICR Details
2900-0768 201408-2900-016
Historical Active 201105-2900-004
VA 2900-0768
Joint Application for Comprehensive Assistance and Support Services for Family Caregivers, VA Form 10-10CG
Revision of a currently approved collection   No
Regular
Approved without change 04/10/2015
Retrieve Notice of Action (NOA) 02/17/2015
  Inventory as of this Action Requested Previously Approved
04/30/2018 36 Months From Approved 04/30/2015
5,000 0 5,000
1,250 0 1,250
0 0 0
This form collects information from applicants for the Caregivers Program.
PL: Pub.L. 111 - 163 1720G Name of Law: Caregivers and Veterans Omnibus Health Services Act of 2010
  
None
Not associated with rulemaking
  79 FR 59562 10/02/2014
80 FR 1992 01/14/2015
No
  Total Approved 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 5,000 0 0 0 0
Annual Time Burden (Hours) 1,250 1,250 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$50,000
No
No
No
No
No
Uncollected
Crystal Rennie 202 632-7492 [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.
02/17/2015