PRA IC List
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Agenda
Reg Review
ICR
Information Collection List
IC Title
Status
Responses
Hours
Dollars
Document Type
Form No.
Form Name
Title 38, Parts 51 and 52, State Home Program
Modified
12884
6818
0
Form
10-0143
Department of Veterans Affairs Certification Regarding Drug-Free Workplace Requirements for Grantees Other Than Individuals
Form
10-0143A
Statement of Assurance of Compliance with Section 504 of the Rehabilitation Act of 1973
Form
10-0144
Certification Regarding Lobbying
Form
10-0144A
Statement of Assurance of Compliance with Equal Opportunity Laws
Form and Instruction
10-10SH
State Homes Program Application for Veterans Care Medical Certification
Form
10-5588
State Home report and Statement of Federal Aid Claimed
Form
10-0460
Request for Prescription Drugs from an Eligible Veteran in a State Home
Form
VA Form 10-3567
State Home Inspection Staffing Profile
Form and Instruction
10-5588A
Claim for Payment for Nursing Home Care Provided to Veterans Awarded Retroactive SVC Connect.
Total burden requested under this ICR:
12884
6818
0
To view an IC, click on IC Title
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