2900-AP83 Ecclesiastical Endorsing Organization

2900-AP83_Ecclesiastical Endorsing Organization

Documents and Forms

Document Name Document Type
Form 10-0379 2900-AP83 Ecclesiastical Endorsing Organization Form and Instruction
10-0379 ECCLESIASTICAL ENDORSING ORGANIZATION VA 10-0379 (12-05v) by Forms in Word 10-25-16.doc Form and Instruction

Information Collection (IC) Details

IC Title:	2900-AP83 Ecclesiastical Endorsing Organization	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

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	10-0379	ECCLESIASTICAL ENDORSING ORGANIZATION	VA 10-0379 (12-05v) by Forms in Word 10-25-16.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	38	38
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.