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Federal forms, ICRs, and supporting documents

Information Collection

Application for Extended Care Services

IC 28899 under ICR 202412-2900-007 · OMB 2900-0629.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

Application for Extended Care Services 2900-0629
 
No Modified
 
Voluntary
 
38 CFR 1.46

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 10-10EC Application for Extended Care Benefits VA Form 10-10EC_revised Dec 2024.pdf Yes Yes Fillable Fileable Signable

Health Health Care Services

 

2,000 0
   
Individuals or Households
 
   50 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 2,000 0 0 0 0 2,000
Annual IC Time Burden (Hours) 3,000 0 0 0 0 3,000
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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