10-10143e Secondary Authorization Request (SAR) for VA Community Care

Expanded Access to Non-VA Care Through the Mission Act: Veterans Community Care Program (VCCP)

Documents and Forms

Document Name Document Type
Form 10-10143e 10-10143e Secondary Authorization Request (SAR) for VA Community Care Form
10-10143e SAR for VA Community Care VA Form 10-10143e_Secondary Auth Request_ Community Care.pdf Form

Information Collection (IC) Details

IC Title:	10-10143e Secondary Authorization Request (SAR) for VA Community Care	Agency IC Tracking Number:	2900-0823

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	10-10143e	SAR for VA Community Care	VA Form 10-10143e_Secondary Auth Request_ Community Care.pdf		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 366,823	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,834,115	1,834,115
Annual IC Time Burden (Hours)	611,372	611,372
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.