Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Claim for Payment for Nursing Home Care Provided to Veterans Awarded Retroactive SVC Connect. New 540 180 0 Form and Instruction 10-5588A
State Home Report and Statement of Federal Aid Claimed New 1668 834 0 Form 10-5588
State Homes Program Application for Veterans Care Medical Certification New 11406 3802 0 Form and Instruction 10-10SH
Title 38, Parts 51 and 52, State Home Program Removed 0 0 0 Form 10-0143
Total burden requested under this ICR: 13614 4816 0  
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