Information Collection

Statement of Accredited Representative in Appealed Case

IC 28158 under ICR 200906-2900-004 · OMB 2900-0042.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0042 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 646 Statement of Accredited Representative in Appealed Case	Form
646 Statement of Accredited Representative Appealed Case 2900-0042 VA Form 646.pdf www.va.gov/vaforms/	Form

IC Title:

Statement of Accredited Representative in Appealed Case

Agency IC Tracking Number:

2900-0042

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 38 CFR 20.600

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	646	Statement of Accredited Representative Appealed Case	2900-0042 VA Form 646.pdf	http://www.va.gov/vaforms/	Yes	No	Fillable Printable

Line of Business: General Government

Subfunction: Legislative Functions

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 38,604

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	38,604	8,142	30,462
Annual IC Time Burden (Hours)	38,604	8,142	30,462
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.