Information Collection

Advanced Directive - Living Will and Durable Power of Attorney

IC 28738 under ICR 200804-2900-023 · OMB 2900-0556.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0556 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form VA Form 10-0137 Advanced Directive - Living Will and Durable Power of Attorney	Form
VA Form 10-0137 VA ADVANCE DIRECTIVE:DURABLE POWER OF ATTORNEY FOR HEALT VA Form 10-0137.pdf	Form

IC Title:

Advanced Directive - Living Will and Durable Power of Attorney

Agency IC Tracking Number:

2900-0556

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 17.32

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 10-0137	VA ADVANCE DIRECTIVE:DURABLE POWER OF ATTORNEY FOR HEALTH CARE AND LIVING WILL	VA Form 10-0137.pdf		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 343,622

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	343,622	87,369	256,253
Annual IC Time Burden (Hours)	171,811	43,684	128,127
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.