Information Collection

VA MATIC Change

IC 28715 under ICR 200612-2900-003 · OMB 2900-0525.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0525 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 29-0165 VA MATIC Change	Form
VA Form 29-0165 VA MATIC CHANGE ENROLLMENT/CHANGE 2900-0525 VA Form 29-0165.pdf www.vba.va.gov/pubs/forms/29-0165.pdf	Form

IC Title:

VA MATIC Change

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	VA Form 29-0165	VA MATIC CHANGE ENROLLMENT/CHANGE	2900-0525 VA Form 29-0165.pdf	www.vba.va.gov/pubs/forms/29-0165.pdf	Yes	No	Fillable Printable

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5,000

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	Previously Approved
Annual Number of Responses for this IC	5,000	5,000
Annual IC Time Burden (Hours)	1,250	1,250
Annual IC Cost Burden (Dollars)	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.