Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
CHAMPVA Benefits - Application, Claim, Other Health Insurance & Potential Liability Modified 177225 46176 0 Form VA Form 10-7959a
Form and Instruction VA Form 10-7959c
Form VA Form 10-7959d
Form VA Form 10-7959e
Form VA Form 10-10d
Total burden requested under this ICR: 177225 46176 0  
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