Written Confirmation of Request for Accommodation; Authorization for Limited Release of Medical Information

Written Confirmation of Request for Accommodation; Authorization for Limited Release of Medical Information

OMB: 2900-0767

IC ID: 192637

Information Collection (IC) Details

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Written Confirmation of Request for Accommodation; Authorization for Limited Release of Medical Information
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form VA Form 0857A Written Confirmation of Request for Accommodation VA0857A.pdf No   Paper Only
Form VA Form 0857d Authorization for Limited Release of Medical Information VA0857d.pdf No   Paper Only

General Government Legislative Functions

 

35 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 35 0 35 0 0 0
Annual IC Time Burden (Hours) 18 0 18 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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.

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