Information Collection

Designee For Patient Personal Property

IC 211131 under ICR 201404-2900-004 · OMB 2900-0817.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 2900-0817 can be found here:

Documents and Forms

Document Name Document Type
Form 10-10118 DESIGNEE FOR PATIENT PERSONAL PROPERTY Form and Instruction
10-10118 DESIGNEE FOR PATIENT PERSONAL PROPERTY 10-10118 DESIGNEE FOR PATIENT PERSONAL PROPERTY 04-07-2014.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	DESIGNEE FOR PATIENT PERSONAL PROPERTY	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 38 CFR 5802

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	10-10118	DESIGNEE FOR PATIENT PERSONAL PROPERTY	10-10118 DESIGNEE FOR PATIENT PERSONAL PROPERTY 04-07-2014.pdf		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 718,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	718,000	718,000
Annual IC Time Burden (Hours)	35,900	35,900
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.