STATEMENT OF APPLICANT AND /OR PHYSICAL EXAMINATION REPORT

ICR 197701-2900-061

OMB: 2900-0087

Federal Form Document

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No forms / supporting documents in this ICR. Check IC Document Collections.
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ICR Details
2900-0087 197701-2900-061
Historical Active 197606-2900-009
VA
STATEMENT OF APPLICANT AND /OR PHYSICAL EXAMINATION REPORT
No material or nonsubstantive change to a currently approved collection   No
Emergency 01/24/1977
Approved with change 01/24/1977
Retrieve Notice of Action (NOA) 01/24/1977
  Inventory as of this Action Requested Previously Approved
05/31/1981 05/31/1981 05/31/1981
10,000 0 60,000
13,333 0 80,000
0 0 0

THE FORM IS REQUIRED BY LAW, 38 U.S.C. 704, 715, 742, 748 AND 781. THE INFORMATION IS USED TO DETERMINE THE APPLICANT'S ELIGIBILITY FOR INSURANCE.

None
None


No

1
IC Title Form No. Form Name
STATEMENT OF APPLICANT AND /OR PHYSICAL EXAMINATION REPORT 29-4465

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 10,000 60,000 0 0 -50,000 0
Annual Time Burden (Hours) 13,333 80,000 0 0 -66,667 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/24/1977


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