Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
10-10143 Election to Receive Authorized Non-VA Care and Selection of Provider for the Veterans Choice Program Modified 5571636 928606 0 Form and Instruction 10-10143
10-10143a Health-Care Plan Information for the Veterans Choice Program Unchanged 528953 88159 0 Form and Instruction 10-10143a
10-10143b Submission of Medical Record Information under the Veterans Choice Program Unchanged 5572600 464383 0
10-10143c Submission of Information on Credentials and Licenses by Eligible Entities and Providers Unchanged 187000 15583 0
Secondary Authorization Request (SAR) for VA Community Care New 869478 289826 0 Form 10-10143e
Total burden requested under this ICR: 12729667 1786557 0  
To view an IC, click on IC Title