Application for Health Professions Trainees - VA Form 2850D

Application for Health Professions Trainees - VA Form 10-2850D

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0205 can be found here:

Documents and Forms

Document Name Document Type
Form 10-2850D Application for Health Professions Trainees - VA Form 2850D Form and Instruction
10-2850D VA Form 10-2850D - Application for Health Professions Tr VHA Form 10-2850D_For Renewal Approval_2019.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Application for Health Professions Trainees - VA Form 2850D	Agency IC Tracking Number:	2900-NEW

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	10-2850D	VA Form 10-2850D - Application for Health Professions Trainees	VHA Form 10-2850D_For Renewal Approval_2019.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 121,000	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	121,000	121,000
Annual IC Time Burden (Hours)	60,500	60,500
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.