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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 201903-2900-033 · 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 Repair queued
30-day FedRegNotice_PRA 2900-0768_VA Form 10-10CG_published_08152019.pdf Supplementary Document Uploaded 2019-10-22 Available
60-day FedRegNotice_PRA 2900-0768_VA Form 10-10CG_published_05222019.pdf Supplementary Document Uploaded 2019-10-22 Available
Prog of Comp Assistance to Family Caregivers_10-10CG_Supp Stmnt A_2900-0768_revised Final_Oct 2019.docx Supporting Statement A Uploaded 2019-10-22 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
197562 Application for Comprehensive Assistance for Family Caregivers Program Form and Instruction Modified
ICR Details
2900-0768 201903-2900-033
Historical Active 201408-2900-016
VA 2900-0768
Joint Application for Comprehensive Assistance and Support Services for Family Caregivers, VA Form 10-10CG
Reinstatement with change of a previously approved collection   No
Regular
Approved with change 03/03/2020
Retrieve Notice of Action (NOA) 01/28/2020
  Inventory as of this Action Requested Previously Approved
09/30/2021 36 Months From Approved
16,500 0 0
4,125 0 0
0 0 0
Public Law (P.L.) 111-163, Caregivers and Veterans Omnibus Health Services Act of 2010 amended title 38 United States Code Chapter 17 by adding a new section, 1720G, “Assistance and Support Services for Caregivers”. Section 1720G requires the Department of Veterans Affairs (VA) to develop a Program of Comprehensive Assistance for Family Caregivers and Support Services. Under the law, primary family caregivers may be eligible to receive a stipend, access to health care coverage, mental health counseling, comprehensive caregiver education and training and expanded respite services. Caregivers may also be eligible for travel benefits when they accompany the Veteran for care or attending training. In order to administer these benefits to caregivers, it is necessary that the VA receive information about the nature of benefit being sought and the persons who will be serving as caregivers and receiving benefits. This form collects necessary information from applicants for the Comprehensive Assistance and Support Services for Family 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
  84 FR 23640 05/22/2019
84 FR 41815 08/15/2019
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 16,500 0 0 11,500 0 5,000
Annual Time Burden (Hours) 4,125 0 0 2,875 0 1,250
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The prior 5,000 data point was the estimated number of applications anticipated for the initial application. Since that time, the program office has received tens of thousands of applications. Over the past eight (8) years since the program has been in existence, the program office has determined that 16,500 would be a fair estimate of continued future applications.
$116,500
No
    Yes
    Yes
No
No
No
Uncollected
Frances O'Donnell 703 405-2449 [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.
01/28/2020