Skip to Content


Proposed Information Collection (Application for Furnishing Long-Term Care Services to Beneficiaries of Veterans Affairs, and Residential Care Home Program) Activity: Comment Request

Document Details

Information about this document as published in the Federal Register.

Document Statistics
Document page views are updated periodically throughout the day and are cumulative counts for this document including its time on Public Inspection. Counts are subject to sampling, reprocessing and revision (up or down) throughout the day.
Published Document

This document has been published in the Federal Register. Use the PDF linked in the document sidebar for the official electronic format.

Start Preamble


Veterans Health Administration, Department of Veterans Affairs.




The Veterans Health Administration (VHA), Department of Veterans Affairs (VA), is announcing an opportunity for public comment on the proposed collection of certain information by the agency. Under the Paperwork Reduction Act (PRA) of 1995, Federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information, including each new collection and allow 60 days for public comment in response to the notice. This notice solicits comments for information needed to determine non-Federal nursing home or residential care home qualification to provide care to veteran patients.


Written comments and recommendations on the proposed collection of information should be received on or before March 16, 2010.


Submit written comments on the collection of information through the Federal Docket Management System (FDMS) at;​ or to Mary Stout, Veterans Health Administration (193E1), Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420 or e-mail: Please refer to “OMB Control No. 2900-0616” in any correspondence. During the comment period, comments may be viewed online through the FDMS.

Start Further Info


Mary Stout at (202) 461-5867 or Fax (202) 273-9381.

End Further Info End Preamble Start Supplemental Information


Under the PRA of 1995 (Pub. L. 104-13; 44 U.S.C. 3501-3521), Federal agencies must obtain approval from the Office of Management and Budget (OMB) for each collection of information they conduct or sponsor. This request for comment is being made pursuant to Section 3506(c)(2)(A) of the PRA.

With respect to the following collection of information, VHA invites comments on: (1) Whether the proposed collection of information is necessary for the proper performance of VHA's functions, including whether the information will have practical utility; (2) the accuracy of VHA's estimate of the burden of the proposed collection of information; (3) ways to enhance the quality, utility, and clarity of the information to be collected; and (4) ways to minimize the burden of the collection of information on respondents, including through the use of automated collection techniques or the use of other forms of information technology.


a. Application for Furnishing Long-Term Care Services to Beneficiaries of Veterans Affairs, VA Form 10-1170.

b. Residential Care Home Program—Sponsor Application, VA Form 10-2407.

OMB Control Number: 2900-0616.

Type of Review: Extension of a currently approved collection.


a. VA Form 10-1170 is completed by community agencies wishing to Start Printed Page 2596provide long term care to veterans receiving VA benefits.

b. VA Form 10-2407 is an application used by a residential care facility or home that wishes to provide residential home care to veterans. It serves as the agreement between VA and the residential care home that the home will submit to an initial inspection and comply with VA requirements for residential care.

Affected Public: Business or other for-profit.

Estimated Annual Burden:

a. VA Form 10-1170—83 hours.

b. VA Form 10-2407—42 hours.

Estimated Average Burden per Respondent

a. VA Form 10-1170—10 minutes.

b. VA Form 10-2407—5 minutes.

Frequency of Response: One time.

Estimated Number of Respondents

a. VA Form 10-1170—500.

b. VA Form 10-2407—500.

Start Signature

Dated: January 12, 2010.

By direction of the Secretary:

Denise McLamb,

Enterprise Records Service.

End Signature End Supplemental Information

[FR Doc. 2010-658 Filed 1-14-10; 8:45 am]