Approved for use
through 9/96 under the conditions that the next submission for OMB
review explains: 1) why this form has not been revised so that it
is relevant to the Gulf War theater and as appropriate, to female
POWs; 2) the extent to which data from medical records and other VA
medical data collections are used to validate responses in this
survey and the results if validated; and 3) in general, why it
continues to be necessary to have such a detailed form in light of
other available medical information. Finally, the submission should
summarize the VA's past experience with this form and any issues
pertaining to general or item nonresponse and validity.
Inventory as of this Action
Requested
Previously Approved
09/30/1996
09/30/1996
750
0
0
750
0
0
0
0
0
This information will be utilized by a
VA physician during a medical examiniation to assess the health
care disability compensation or rehabilitation needs of the former
Prisoner of War.
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.