Information Collection

Former POW Medical History

IC 28634 under ICR 200610-2900-001 · OMB 2900-0427.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0427 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 10-0048 Former POW Medical History	Form
10-0048 Former POW Medical History 2900-0427 VA Form 10-0048.pdf vaww.va.gov/vaforms	Form

IC Title:

Former POW Medical History

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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
Form	10-0048	Former POW Medical History	2900-0427 VA Form 10-0048.pdf	http://vaww.va.gov/vaforms	Yes	No	Fillable Printable

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 75

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	Previously Approved
Annual Number of Responses for this IC	75	-975	1,050
Annual IC Time Burden (Hours)	113	-1,462	1,575
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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