Information Collection

Written Consent To Release Medical Records Protected_by 38 U.s.c. 7332 -- 38 Cfr 1.475(a)

IC 148397 under ICR 199307-2900-012 · OMB 2900-0544.

Documents and Forms

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Document Name	Document Type

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IC Title:

WRITTEN CONSENT TO RELEASE MEDICAL RECORDS PROTECTED_BY 38 U.S.C. 7332 -- 38 CFR 1.475(A)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Migrated

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20,640

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1	1
Annual IC Time Burden (Hours)	1,720	1,720
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.