Information Collection

Application for Physicians, Dentists, Podiatrists, Optometrists and Chiropractors - VA Form 10-2850

IC 257916 under ICR 202301-2900-008 · OMB 2900-0205.

Documents and Forms

Document Name Document Type
Form 10-2850 Application for Physicians, Dentists, Podiatrists, Optometrists and Chiropractors - VA Form 10-2850 Form and Instruction
10-2850 Application for Physicians, Dentists, Podiatrists, Optom vha-2850-fill.pdf Form and Instruction
10-2850 Application for Physicians, Dentists, Podiatrists, Optom VA Form 10-2850.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application for Physicians, Dentists, Podiatrists, Optometrists and Chiropractors - VA Form 10-2850	Agency IC Tracking Number:	2900-0205

Is this a Common Form? Yes		IC Status: New

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 and Instruction	10-2850	Application for Physicians, Dentists, Podiatrists, Optometrists and Chiropractors - VA Form 10-2850	VA Form 10-2850.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 16,128	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	16,128	16,128
Annual IC Time Burden (Hours)	8,064	8,064
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.