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⚠️ Notice: This information collection may be referencing outdated material.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

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.