Information Collection

Forms Relating to Military Service Records

IC 32546 under ICR 201106-3095-002 · OMB 3095-0039.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3095-0039 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form NA 13036 Forms Relating to Military Service Records	Form and Instruction
NA 13036 Authorization for Release of Military Medical Patient Re NA 13036_11FINAL.docx www.archives.gov/st-louis/military-personnel/public/medical-records-veterans-access.html	Form and Instruction
NA 13042 Request for Information Needed to Locate Medical Records NA 13042_11FINAL.docx www.archives.gov/st-louis/military-personnel/other-medical-records.html	Form and Instruction
NA 13055 Request for Information Needed to Reconstruct Medical Da NA 13055_11FINAL.docx www.archives.gov/st-louis/military-personnel/alternate-record-sources.html	Form and Instruction
NA 13075 Questionnaire about Military Service NA 13075_11FINAL.docx www.archives.gov/st-louis/military-personnel/alternate-record-sources.html	Form and Instruction

IC Title:

Forms Relating to Military Service Records

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 36 CFR 1233.18

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 and Instruction	NA 13036	Authorization for Release of Military Medical Patient Records	NA 13036_11FINAL.docx	http://www.archives.gov/st-louis/military-personnel/public/medical-records-veterans-access.html	Yes	No	Fillable Printable
Form and Instruction	NA 13042	Request for Information Needed to Locate Medical Records	NA 13042_11FINAL.docx	http://www.archives.gov/st-louis/military-personnel/other-medical-records.html	Yes	No	Fillable Printable
Form and Instruction	NA 13055	Request for Information Needed to Reconstruct Medical Data	NA 13055_11FINAL.docx	http://www.archives.gov/st-louis/military-personnel/alternate-record-sources.html	Yes	No	Fillable Printable
Form and Instruction	NA 13075	Questionnaire about Military Service	NA 13075_11FINAL.docx	http://www.archives.gov/st-louis/military-personnel/alternate-record-sources.html	Yes	No	Fillable Printable

Line of Business: Education

Subfunction: Cultural and Historic Preservation

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 79,800

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	79,800	79,800
Annual IC Time Burden (Hours)	6,650	6,650
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.