Application for Comprehensive Assistance for Family Caregivers Program

Program of Comprehensive Assistance for Family Caregivers (PCAFC) - AR96

Documents and Forms

Document Name Document Type
Form VA Form 10-10CG Application for Comprehensive Assistance for Family Caregivers Program Form and Instruction
VA Form 10-10CG Application for the Program of Comprehensive Assistance VA Form 10-10CG.pdf www.va.gov/vaforms/medical/pdf/10-10CG.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Application for Comprehensive Assistance for Family Caregivers Program	Agency IC Tracking Number:	2900-0768

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 71

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	VA Form 10-10CG	Application for the Program of Comprehensive Assistance for Family Caregivers	VA Form 10-10CG.pdf	http://www.va.gov/vaforms/medical/pdf/10-10CG.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: “Patient Medical Records --VA” (24VA19), “Enrollment and Eligibility Records --VA” (147VA16), and “Health Administration Center Civilian Health and Medical Program Records--VA” (54VA17)	FR Citation: 69 FR 18428

Number of Respondents: 140,671	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 75 %

	Requested	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	140,671	30,000	110,671
Annual IC Time Burden (Hours)	35,168	7,500	27,668
Annual IC Cost Burden (Dollars)	0	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.